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More industry experts weighing in on improving health care

Health Care and Health Insurance
by Chris Merkel
More industry experts weighing in on improving health care
More industry experts weighing in on improving health care

One of the biggest points of consensus in the U.S., almost regardless of background, political affiliation or any other demographic breakdown, is the understanding that certain aspects of the national health care system need reform. Costs continue to rise sharply, and while there may be many approaches considered when it comes to addressing that fact alone, there are certain aspects of the system most Americans feel should be untouchable.

For instance, a recent poll of Texans found that 88% believe insurers should be required to cover people's pre-existing conditions regardless of what they are, according to the Episcopal Health Foundation. In addition, 91% percent say state governments need to have at least some role in ensuring the health care systems within their borders are functioning properly, and 82% felt the same way about the federal government as a whole.

Health care can work well when more organizations work together.Health care can work well when more organizations work together.

What do people want?
Not only do people want their state governments to have more involvement in health care as a whole, they also have pretty clear ideas about what oversight the government should have, the report said. For the majority of those polled - 54% - a key component of that involvement is increasing spending. In fact, health care spending trailed only funding for education in terms of what respondents felt was most important for state governments to address.

"57% felt it was vital to increase everyone's access to health insurance."

In addition, 3 in 5 residents of the Lone Star State wanted to see more done by lawmakers to bring down prescription drug prices, just ahead of the 59% who felt the same way above the cost of treatment, the survey found. Furthermore, 57% felt it was vital to increase everyone's access to health insurance, and 53% hope for more funding for mental health. Another 51% wanted to funding to address infant and maternal mortality rates.

Almost 60% also felt state governments don't do enough to ensure low-income residents have access to quality health care, and even more - 64% - want to see Medicaid expanded, the report said. Elena Marks, president and CEO of the Episcopal Health Foundation, noted that because Texans seem to know what they want from lawmakers when it comes to health care, that makes it incumbent upon those elected officials to do something to create positive change in the system.

Different approaches
At the same time, those within the medical profession also think it's important for the industry to do more on its end - without government oversight - to ensure broader access to more affordable care. The Association of American Physicians and Surgeons recently released a list of items its members widely feel is important as it relates to improving choice, competition and spending cycles in the U.S. health care system writ large.

The biggest issues doctors see right now include, but are certainly not limited to, reduction of fraud and waste due to third-party payment options, rolling back restrictive regulations, the mix of private and public insurance options not necessarily being conducive to choice and reforming government-run systems like Medicare and Medicaid. To that end, the AAPS recommends eliminating rules that block access to options outside traditional insurance channels, while still letting people keep the coverage they have through public or private insurers, so long as it fits their needs.

Furthermore, the organization believes more needs to be done to encourage transparent pricing for care, prescriptions and so on. It would also like to see more options to cover health care costs allowed into the system, so that people can pay for just about any type of treatment with health savings accounts, reimbursement arrangements and the like. In addition, because the way individuals pay for coverage is taxed differently than if they pay for employer-sponsored insurance, eliminating those tax rules would also likely be a benefit.

Finally, like individuals in Texas, the AAPS wants to see more options for addressing pre-existing conditions and keeping costs down brought into the health care field, such as by allowing the creation of new insurance products that are specifically for people who suffer from these illnesses, the report said.

"High-need, high-cost patients are huge drivers of health care costs and resource use."

Why it's important
The fact of the matter is that while the U.S. spends more per capita on its health care than almost every other industrialized country with a large population, much of that expense is centered on care for relatively few patients, according to Health Affairs. So-called high-need, high-cost patients are huge drivers of health care costs and resource use, and many care providers now have specific plans in place to more effectively address their needs. That, in turn, may allow those organizations to keep their higher-risk patients healthier while also keeping the costs needed to treat them across a variety of care options more compressed.

A recent study found that 85% of accountable care organizations have already put some kind of strategies to address HNHC treatment needs, the report said. More anecdotally, those that report having success with these programs have taken a more holistic approach to the effort, even as most organizations don't have a single definition of what constitutes an HNHC patient.

For instance, 80% of organizations studied said they have transitional care management programs in place to make sure patients can get from one care facility to the next, and almost as many have instituted programs that allow health care staff to coordinate care across those myriad locations, the report said. However, fewer than 2 in 5 respondents said that they have been able to fully implement their plans to better serve HNHC patients. This was often due to a lack of funding or patient engagement (both cited 65% of the time) but other issues like a lack of actionable data, resistance to the programs from physicians, geography, scalability and more were also cited by more than a third of those examined.

What about employers?
Businesses, which are the most common channel through which people obtain health insurance in the U.S., also have a significant role to play in solving some of the problems in the health care system, according to the Harvard Business Review. However, they likely know that better than anyone, given their costs per enrollee spiked 44% between 2007 and 2016, and they collectively spent $700 billion on coverage in 2017.

"Costs per enrollee spiked 44% between 2007 and 2016."

Many large companies, with the capital and clout to make "disruption" easier to tackle, are directly contracting with care providers instead of providing traditional insurance options to employees, so as to better cover costs they can directly negotiate, sans middle man, the report said. This includes as major corporations like Walmart, General Electric, Boeing and more. However, those efforts likely aren't feasible for smaller companies, so other initiatives are gaining popularity as well. Many are simply shifting more health care costs to employees themselves, which experts say is an arrangement that doesn't leave anyone particularly happy.

As such, even businesses are trying to negotiate prices more directly with care providers, the report said. As recently as 2017, just 6% of companies undertook or were considering such efforts, and that number ballooned to 22% this year.

Experts in both the business and health care spheres agree: There is no one-size-fits-all solution to this problem because no two businesses have the same health-related concerns, the report said. But as long as companies try to find ways around traditional methods of dealing with health care inefficiencies - be they cost or logistical - it's likely that at least some more effective solutions will arise.

Care providers playing their part
In addition to coming up with plans to keep spending on specific patients down, it may also be vital for care providers to more efficiently serve all patients regardless of the severity of their condition, according to Dr. William Haseltine, Ph.D., former head of the Dana-Farber Cancer Institute laboratories in cancer and HIV/AIDS research and Harvard Medical School professor, writing for Stat News. That can include taking a better approach to staffing and scheduling to ensure a consistent quality of care, updating facilities as much as is reasonable and so on.

Such a commitment starts at the top, as leading decision-makers for any care provider need to have a clear vision of what their problems are and what options exist to most effectively address them, the report said. In many cases, this may be as simple as doing a better job - from top to bottom within the organization - of determining which tests and scans are necessary and which are not. In addition, experts say it's vital for care providers to commit to compiling and utilizing as much data as possible, in real-time whenever feasible. That can be a big help in the billing department, in particular, where inefficiencies can add up quickly and lead to issues for patients, insurers and even government agencies.

Certainly, everyone has their role to play in the health care system as a whole and reform is likely to come through close collaboration between all participants. The more companies and government organizations can do to make sure they are addressing their own issues while also reaching out to their own partners in the health ecosystem, the better off all involved are likely to be going forward. That may be especially true for patients.

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