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 offer care coordination delivered through primary care and community services, supported with patient controlled medical records, education, training, and clinical guidelines, and managed via additional and adjustable payments from patients for non-compliance with established guidelines, treatment plans, and best practices.
For example, patients who don’t schedule an appointment and meet with their physician within a specified time after a major surgery pay a penalty. Patients who do not follow their treatment plan as agreed to between their doctor(s) and themselves pay a penalty. Consumers who do not get preventive screenings when required pay a penalty. Patients must have open access to care, while not being able to disregard tests, treatments, and care that results in safer, more efficient healthcare without penalties.
The critical consumer accountability piece must be added into any new system because the overwhelming majority of clinical outcomes and overall health are determined by decisions and actions that consumers make outside of any clinical setting.