Effective, Efficient, Healthcare: a New Patient-Centered Vision

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.





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