I have been dreaming of a future healthcare delivery system that will provide Affordable Health Care and Beyond for ALL Americans and would like to share with you an “and Beyond” concept that I feel is better than what we have now. I have lived long enough to have had many encounters in our healthcare system–personally and indirectly through friends and family members. Writing this blog has opened my eyes to how messed up our healthcare system actually is and has got me thinking of how I would improve it. At first, my thoughts mimicked the piecemeal approach that has been the approach of our national healthcare policy for the past fifty years. I quickly realized that the problems in our healthcare system are much more structural in nature. Leaving the delivery of quality patient outcomes in the hands of individual private healthcare businesses (doctors and hospitals) is not working well. Private healthcare businesses have very real financial conflicts of interest that pit maximizing income and profits against delivering the best outcomes for patients.
I have come to realize that a necessary ingredient of healthcare reform in our country must center on redefining the very nature of health care from one that is healthcare-business-centered (fee-for-service care) to one that is “patient”-centered. The financial interests of those who benefit financially from health spending must take a backseat in national healthcare policy. My vision for a future healthcare delivery system is not going to happen anytime soon because too much money is currently being made by various politically powerful, special interest groups who would strongly oppose all threats to their cash stream.
My Future Healthcare Delivery System
At the center of my future healthcare delivery system is the community healthcare center. These are facilities that are scattered across communities (much like police and fire facilities) in all parts of the United States. Because people might require health care at all hours of the day and even on a Sunday, the community healthcare center will be open 24 hours a day and 7 days a week (including holidays). These community healthcare centers would be staffed by a wide variety of healthcare workers (medical doctors, nutritionists, psychologists, pharmacists, etc.) whose primary job is to their keep Americans healthy, cure disease, or manage what they cannot cure. As shown in the figure below, healthcare consumers will be divided into those seeking before sickness care, those seeking nonemergency after sickness care and those seeking emergency after sickness care. A nonemergency care patient can become an emergency care patient after evaluation by appropriate healthcare professionals.
The care provided at the community healthcare centers will be built on the following guiding principles:
- All Americans will have access to care (universal) which is provided based on clinical need versus the on the ability to pay.
- Healthcare consumers will not have to worry about insurance plan coverage, networks, coverage denials, or any other billing items. They will not have to worry about going bankrupt if they get very sick. All medically necessary health care will be provided to all.
- Healthcare workers will strive for the highest quality and most efficient care (i.e., delivering healthcare value). Healthcare worker pay (and promotions) will be based on the quality of care delivered and not on the quantity of care. Healthcare consumers (both patients and the healthy) will be treated like whole persons and not like a collection of medical codes for reimbursement. The fee-for-service payment model will totally disappear.
- Healthcare services are “patient”-centered (puts the interests of healthcare consumers ahead of the financial interest of healthcare business). Healthcare workers who deliver care in the community healthcare centers are accountable to the public, communities, and healthcare consumers that they serve.
- “Patient”-engagement, especially in before sickness care, and education will be emphasized in my future healthcare delivery system.
- The power of computers and electronic health data will be harnessed. At the heart of the community healthcare centers will sit a system of networked supercomputers which will handle the storage and use of individual electronic health records, coordination of care logistics, and special programs which utilize various medical databases for improved, and constantly evolving, medical practice. This data will include drug interaction checkers, medical research for the development of evidence-based clinical guidelines, and symptom databases. The supercomputer will be capable of analyzing large amounts of medical data, understanding questions posed to it in plain English, and proposing evidence-based answers to medical problems. The delivery of the “best” medical care will no longer have to rely on the limited knowledge and clinical expertise of single medical professionals. These healthcare supercomputers already exist but are being used for the most cost-effective care of all Americans. Private companies are buying individual patient healthcare data and packaging it into products they can market for maximum profit.
The figure below shows how my future healthcare delivery system will harness the power of supercomputers over the Internet for use in community healthcare centers across the United States.
What is so Different about this Future Healthcare Delivery System?
It is natural to read the outline for my future healthcare delivery system above and think of systems already in existence. Many of the “patient”-centered principles I describe above are also found in Great Britain’s National Health Service’s NHS Constitution for England. Closer to home, one can also argue that my future healthcare delivery system is simply an enlargement on the Veterans Health Administration’s network of healthcare facilities to serve all Americans, rather than just a small subset of Americans.
My future healthcare delivery system differs from both Great Britain’s National Health Service and the Veteran Health Administration’s healthcare system is fundamental ways. While both are applying computers and electronic health data to “support” their healthcare delivery systems, computers and electronic health data are “central” to the care delivered in my future healthcare delivery system. My future healthcare delivery system also rests on the “central” idea that before sickness health care is just as important (if not more important than) after sickness care with COORDINATION of care is strongly emphasized for true “patient”-centered care.
While I show my future healthcare delivery system being housed in one community healthcare center, health care can be delivered in multiple dwelling. I represent my future healthcare delivery system as one building serving a community of Americans for simplicity and to emphasis that healthcare facilities should financially benefit the payers of healthcare and not the for-profit healthcare businesses currently building new healthcare facilities all across the country at a furious rate.
My future healthcare delivery system above does not say anything about who employs the healthcare workers, who “owns” the community healthcare centers, or how the health care is funded. These are details to be optimized and are not foundational principals (see the six points above) governing my future healthcare delivery system. Our government does not have to “own” the community healthcare centers in my future healthcare delivery system, but it does have to support the six principles outlined above in a strong health policy. Government healthcare policy must not politicize the delivery of healthcare nor can it put private healthcare businesses ahead of the Americans getting care.
Efforts currently underway by our government (primarily through the Centers for Medicare and Medicaid Services (CMS)) involve piecemeal government payment reform initiatives that are aimed at “incentivizing” for-profit private healthcare businesses to deliver quality over quantity of care. The Accountable Care Organization (ACO) and the Patient-Centered Medical Home (PCMH) are two examples of such voluntary programs for private healthcare businesses. These limited initiatives will never achieve the quality and cost benefits built into my future healthcare delivery system because they are not truly “patient”-centered, computer/healthcare data-driven health care systems. These initiatives operate within the established framework of our broken healthcare system where the financial interests of private healthcare businesses take precedence over the needs of healthcare consumers.
In the next few blog posts, I will describe how health care is delivered in my future healthcare delivery system under different health scenarios.