As Washington and just about everyone else struggles with healthcare reform it seems sensible to share a more patient-centered vision of healthcare’s future.

To start with, preventive, primary, and emergency care should be provided for everyone, regardless of ability to pay, through a patient-centered, primary care physician led medical home model; via a tax funded system; such as Medicare/Medicaid. Emergency care providers would use initial assessments to either admit patients, or send them directly to available primary and community care services.

A basic level of specialty care can then be delivered through integrated primary, specialty, hospital, ambulatory, rehab networks, and manged through primary care physicians using the medical home and/or coordinated care model.

Additional specialty care, such as advanced treatments, drugs, and procedures can be acquired through private, commercial insurance. Economically disadvantaged patients can also be offered advanced treatments through clinical trials, industry assistance programs, charitable organizations, and crowd-funding.

Community services, which are the backbone of many who are less fortunate and mentally ill, can be coordinated with preventive, primary and emergency care, and funded through federal block grants to communities through each state.

Elimination of online and overseas prescription drug purchasing restrictions, combined with enhanced compliance, testing, and quality control  oversight.

One of the missing elements of virtually every plan currently under consideration is patient accountability. The future of any successful healthcare delivery system must promote patient acountability and care coordination. prevention, care, and care management must be delivered through a network of primary care providers, and managed through self-management, caregivers, and PCPs. Patients must have open access to care, and be financially incented not to disregard preventive sreenings, treatment plans, and care that is proven to result in safer, more efficient healthcare.

PCPs can use patient-education, digital medical records, technology, clinical guidelines, and services as needed for each specific patient based on their individual health and life circumstances.

Actual utilization for the basic primary and specialty services noted can be measured and optimized through the primary care provider, and patient accountability can be supported through adjustable payments and rates for non-compliance with established guidelines, treatment plans, and best practices. With this model, more advanced specialty care would be maned by the patient and their private insurance provider through their PCP and specialists.

For example, patients who don’t schedule an appointment and meet with their physician within a specified time after a major surgery or patients who do not follow their treatment plan pay a rate penalty. Likewise, consumers who do not get preventive screenings when required also pay financial penalties.

In the end, consumer accountability must be integrated into any new healthcare delivery system or the sytem is doomed to sub-optimal perfromance. The optimal outcome of any health event is determined by largely decisions and actions that consumers and patients make outside of any clinical setting.

 

 

 

 

The only way to deliver optimal healthcare to every American is to rebuild the system around consumers as the leaders of their healthcare teams; not just as partners. This means restructuring health education, training, payments, medical information, tools, and resources to support informed consumer decision-making, care coordination, and care management from adulthood through death.

Much of this is already going on. Consumers have been voting with their money for over a decade by purchasing more and more over-the-counter medications and products, implementing new preventative technology tools, and purchasing higher deductible  insurance plans, and more.

We can change the entire trajectory of healthcare spending and quality with a new model that recognizes consumers as the master of their own bodies and health and keeps them accountable for their life choices. Health information management, prevention, early detection, treatment plans, follow-up, care coordination, compliance, and personal well-being must all be supported through new tools. Yes, medical professionals and the healthcare industry must compete in a free market to provide the resources, tools, training, treatments, technology, and support services that will be needed.

The reason that this new model is the only way to rebuild an optimal healthcare system is deeply rooted in the basic fact that the overwhelming majority of healthcare outcomes are based on personal choices people make about their life, every day outside of a clinical setting. The notion that doctors, hospitals, healthcare professionals, and community providers are responsible for our health must be thrown aside to usher in a new age of consumer accountability.

10 Tips for Getting Safe, Quality Healthcare

 

• Be involved in all parts of your healthcare.
• Ask questions whenever you are unsure of anything related to your healthcare.
• Whenever possible, find out how much you will be expected to pay before appointments, tests, and treatments are started.
• Request copies of your test results, doctor’s notes, and medical record when you check in for any appointment, test or treatment.
• Always find out how much successful experience your health providers have at diagnosing and treating your specific condition.
• Keep and organize copies of your medical records, test results, and interactions with all of your healthcare providers.
• Learn as much as you can about your illness and providers from trustworthy sources.
• Contact your insurance provider as much as needed to understand your coverage, your insurance provider’s guidelines, and your financial responsibilities.
• Negotiate fees with doctors and treatment providers whenever possible.
• Review your bills for mistakes.
• Consult an experienced specialist after a serious diagnosis.