In his February 23, 2013 article in the New York Times, Richard Thaler, noted professor of Economics at the Booth School of Business at the University of Chicago, makes several suggestions on how to improve US health care.
Among them are:
- Paying doctors and hospitals for health, not illness treatment
- Using evidence-based medicine approaches
- Making more efficient use of nurse practitioners, pharmacists, physician assistants and other medical professionals
- Opening opportunities for all patients to have end of life discussions
- Implementing safe harbor from medical liability under certain situations
- Incremental changes and experiments with innovation to improve the US health care approach
These are all good ideas that have been under discussion, some for many years. I agree with the ideas, but I would argue in favor of reaching further, reaching for transformational changes. To amplify this thought:
- The Affordable Care Act opens the door for Accountable Care Organizations (ACOs). Well designed ACOs have the potential to transform US healthcare in many ways:
- End of Life discussions and planning are not “death panels,” and we cannot, and must not, get tangled up in arguments based on inaccurate assumptions as a way to avoid these needed discussions.
A healthcare system implies a uniform, defined approach to problem—something the US does not have. We have a fragmented, expensive sector not designed with the goal of improved health, but organized around principles where the main benefactor is the entire healthcare industry, not the patient. I don’t think we need more experiments; we need transformational change with the goal of achieving the Triple Aim of improving healthcare quality and satisfaction, improving population health, and reducing the cost of healthcare.
Dr Michael L Taylor
Chief Medical Officer
Complementary to the “Hospital at Home” is the team approach of the Patient Centered Medical Home (PCMH) - not a new concept, but a model that fulfills healthcare reform goals by focusing on making the patient centric in the delivery of health care. Much like the Hospital at Home, the PCMH provides primary care at a community level, actively allowing the patient and their family to participate in their healthcare decisions. It too shows strong results.
The Patient Centered Primary Care Collaborative has monitored the performance of various PCMH models throughout the country and in 2012 published a report of the positive outcomes the initiatives are experiencing including, reduced emergency department events, reduction in hospital admissions, lower inpatient days, and lower readmissions. The chronically ill patient benefits from a care team made up of physicians, navigators, social services, and others in the medical neighborhood that focus on keeping the patient well, satisfied, and out of the hospital.
Senior Consulting Manager