Getting beyond the talk on healthcare costs; Why the president of Aetna, Mark T. Bertolini needs to read Forbes Magazine

Getting beyond the talk on healthcare costs; Why the president of Aetna, Mark T. Bertolini needs to read Forbes Magazine

Everyone who is anyone in healthcare agrees something has to change in our healthcare system. The system is wasteful, creates fear, has a lousy record with chronic disease processes and often rewards less effective, more expensive providers of services. For years, the healthcare environment was steered through lower co payments and deductibles, which has been replaced by high deductible plans that often restricts people from going to healthcare providers who are outside the network you are in.

Often, more effective providers are not in the networks simply because they are paid below their cost of providing the services. The insurance industry wrongly believes that by restricting out of network access, they will improve the quality of care.

Recently, the president of Aetna, one of the USA’s largest insurers had some suggestions on how to curb future healthcare costs which included

  • Enable customers to take control of their healthcare through connected, digital tools.
  • Move “carrots away from the highest-cost centers” such as hospitals to reward providers delivering high-quality care for far less.
  • Align payer incentives with providers, and partner to deliver a “win-win” proposition.
  • Patients need to see healthcare service as an investment in their health and financial security.
  • Invest in wellness. While it will likely be a 25- to 30-year experiment, it is necessary to see if the United States can improve health outcomes and reduce the incidence of disease.
  • Better manage chronic disease. The number of Americans suffering from chronic disease conditions is almost as staggering as the costs associated with caring for these health problems. “The chronically sick deserve focus factories that deliver better care,” Bertolini says.

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The problem is what is quality and what is not. In many countries, they do more with less, while the statistics suggest that less is more in healthcare. This is especially true with the elderly population which often are taken care of palliatively as they enter their 80’s and 90’s. Often, families are faced with grave consequences if they do not try an expensive, life saving procedure, only to find out their loved one never survived or recovered from the surgery itself.

Recently I was in Florida and heard first hand a number of story’s that illustrated this point, where an aging patient in their upper 80’s was told they required a life saving procedure that prematurely ended their life, which by the way costs sometimes hundreds of thousands of healthcare dollars with no difference in the outcome or quality of life. In many of these cases, suffering is extended and the doctors move on to their next victim.

Of course, this is just one way healthcare costs are wasted. Many healthcare provider groups, such as chiropractors are under utilized, while many of those same cases can go months for physical therapy without a satisfactory outcome, or worse, with a surgical procedure rather than a cure, and at a significantly higher cost.

While many doctors believe that drug companies are looking for a cure, as a local doctor I sat next to on a recent plane trip suggested, the reality is, that is not their model. Basically, drug companies are looking for people to take on a long term prescription that renews, just like a magazine would, in perpetuity. If you doubt that, then take a look at how we cure blood pressure, diabetes, and other chronic problems; these are not cures, but ways to manage the problem medically. Perhaps, we need a fresh look at why these problems have not been solved or perhaps, better ways of understanding the systems behind the physical problems we experience, especially as we age. In the end, all this management costs money and require doctor visits.

What would a wellness model look like? Perhaps, the way we look at blood tests may need to be more holistic, with the primary doctor being able to spend the time, and consider non drug options. There are many of those. For the musculoskeletal system, do we look at where you hurt or perhaps, begin to understand why?

Recently, Forbes came out with two articles on this which are worth reading. Here are links to those articles.

We all agree that healthcare needs to change, the question is who will change it, and with which ideology. It is quite likely that Obamacare will eventually result in Medicare for all, after the Aetna’s of the world fail to fix the problem; probably because they are a huge part of the problem itself.

Perhaps, we need to look at the entire system, and not just take for granted the current players need to stay (drug companies, massive amounts of medical specialists) and move back to a simpler model that looks at wellness, simplicity, and how to cure, rather than to manage. For that to happen, we need to shake up the system with new players and new different ideas and realize that until we figure out how to eliminate aging, that the process is inevitable, not a disease, not something that requires procedures and management but does require respect and support for the aging population.

What do you think? As always, I welcome your opinions.