The COVID-19 pandemic has exposed both the best and the worst of our nation’s healthcare system. On the positive side, we saw our healthcare heroes selflessly care for patients at significant personal risk and much well-deserved public appreciation for the service they provide each day. Alternatively, the pandemic has highlighted the fragility and fragmentation of our current healthcare structure.
The antiquated financial foundation of our healthcare structure featuring the continued use of fee for service as a payment model doesn’t work amid a public health crisis. Arguably, it doesn’t work well at any time. Payment for services used — based solely on condition, anatomy or selected circumstances — runs counter to prevention, wellness and sound financial principles.
Once the pandemic is solidly behind us and we learn its total cost to our country, a sea change is likely. Healthcare consumers will demand change, no longer tolerating a continued rise in healthcare costs. This change is essential and overdue. Transitioning our healthcare system to one that treats the whole person but has individual, and collective accountability for the result is an excellent place to start. We can’t avoid the fact that healthcare is not cheap, and eventually, someone has to pay for it, but it shouldn’t be the burden of any one segment of our society. Healthcare is a human right, but this doesn’t mean any service at any time, with any provider or tool/technology. These types of choices are part of what creates misuse and overuse. Healthcare services should still be medically necessary.
A better approach is to modify the current healthcare payment structures to support appropriate use of services. Assigning all parties involved in the process with a level of accountability for clinical and financial outcomes makes more sense. Achieving superior population health — the real goal — will require change beyond the payment model. It is however a reliable place to start. Moving the economics from fee for service to a capitated (fixed) payment for a range of services will help align incentives.
Currently payment models focus on the medical “fix” as compared to wellness and prevention. This is not a sustainable approach. Rather, it is essential to shift funding to address the influencers of poor health outcomes, including those beyond individual behavior and genetics, including economic disparities, environmental conditions, education level, healthcare access and societal conditions.
Changing healthcare is a daunting task and real change will take years, but we can, and should, begin with small changes and build from there. Changing the economic model, as described above, will help create value by improving quality and cost. However, for continued improvements, the focus must be on population health, which will eventually address determinants of health. Value-based care linked with population health strategies are showing promise in various markets across our country. Healthcare in our region, must follow suit or fall behind or even worse, risk disruption by others that see opportunity.
What we need is the will for more dramatic change and tangible commitment by all involved; this is what will produce a sustainable healthcare environment. Yes, our healthcare system is complicated and challenging, but it offers much promise to so many. Population health and value-based care are a starting point in this journey, and these strategies have demonstrated that we can achieve meaningful change.
Lisa Trumble is President & Chief Executive Officer at SoNE Health