• Skye Solutions Nashville

Sick Care in the United States is Killing US

The United States does not have a healthcare system. We have a sick care system where medical providers (i.e., hospitals, clinics, physicians, etc.) are largely paid to treat health problems after they manifest (once people get sick) rather than help people stay healthy. There is less emphasis placed on—and very little money earned—helping people stay healthy.

The offspring of the sick care business model is a fee-for-service payment model, where medical services are unbundled and paid for separately. In this system, medical payments are dependent on the quantity of care provided rather than the quality of care or health outcomes achieved. And when medical providers get paid to do more, that is exactly what consumers receive, sometimes, whether they need it or not.

Further, because there is little attention paid to managing health, people end up in the sick care system who never should have gotten that sick. The payers (i.e., commercial health insurance, Medicare, and Medicaid) pay mostly for fixing people after they become sick or keeping symptoms suppressed on an ongoing basis for the diseases that supposedly cannot be cured. This results in a lot of misery for many people, and growing costs for all of us.

As mentioned earlier, a rarely admitted, but fairly well-established fact is that when you have a fee for service system you get more services than you need. Approximately 30 percent more, in fact. Brent James, MD, the highly respected director of the Institute for Healthcare Delivery Research recently reported to Congress that 50 percent of what we spend on healthcare is wasted.

Add to this the fact that there is an emerging epidemic of chronic illness sweeping this nation, and it is little wonder why healthcare spending is going through the roof. In addition, the "doctor as expert" approach is not very effective at getting to root causes. It simply provides 15-minute office visits and prescriptions that suppress symptoms. More often than not, the root cause of poor health stems from unhealthy lifestyle choices. The result is that the healthcare system is being overwhelmed, and costs are killing us at a rate that has increased over 250 percent during the past 20 years.

As we point out in our book, Healthcare is Killing Us: The Power of Disruptive Innovation to Create a System that Cares More and Costs Less, it has been demonstrated that if providers working with chronic illnesses can spend more time helping people change their lifestyle and work on the social determinants of health, remarkable results can be achieved. These provider groups, including primary care physicians, allied health practitioners (PAs and NPs), nutritionists, health coaches, and sometimes, behavioral health professionals, work together over months to help each patient make better lifestyle choices. When longer-term support is added to the care mix, peoples’ health can improve dramatically.

Under the fee-for-service payment model, this approach to improving health is unaffordable. But in a payment model where providers go ‘at risk’ for a certain population (e.g., employees and family members of a large company, the Medicaid population of a state, etc.) providing healthcare instead of just sick care can bring about remarkable results.

Case in point is a medical provider named IORA, who contracts with companies for a set annual price to take care of their employees and their families. IORA works hard at developing a health-oriented partnership with the employees, and in addition to medication, if necessary, provide coaching and counseling over time to facilitate and support a healthier lifestyle. Their results are remarkable, reducing hospital admissions by 40 percent and lowering their client companies' healthcare cost by 15 percent to 20 percent.

In this model, which is beginning to take hold across the country, we are able to invest in true health care. This significantly reduces the need for sick care and lowers health costs dramatically. Everyone, except legacy medical providers who are unwilling or unable to adapt, wins.

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