How to Pay for Healthcare Reform, Part 2

We asked in part 1 how we can pay for healthcare reform, stating the simple answer is to determine what saves money while improving care, and then focus our attention. In this regard, there are 12 fundamental steps that we practitioners must consider, what I call The 12 Cs of Avoiding Waste, Duplication, Irrelevancies, and Inefficiencies While Focusing on the Patient.

1. Create Cost-efficient Care - Outcomes research, applied in the field can improve the access and quality while restraining, if not reducing the costs of care.
2. Improve Caring - Enhancing clinician's workflow while improving follow-through and follow-up will achieve greater healthcare benefits. Example: preventing readmissions as in congestive heart failure.
3. Create Choices - There must be some reasonable level of accountability for adverse lifestyle choices. (Genetic predisposition must only be considered when it is or could be a major contributing factor.)
4. Have Corrective Action Plans - Improve quality without adversely affecting efficiency. Improve diagnostic processes and thereby the practitioner's accuracy, “preventing, minimizing, or mitigating diagnostic errors.”
5. Know the Context - Thoroughness is impossible unless one understands the patient's past, present and possible future needs. For example, billing codes must no longer dictate the availability of evaluation and management services.
6. Capture the Clinical Story - The private story of the patient is a dynamic history: Having a longitudinal record is recommended because it captures the most important items in an organized problem list.
7. Utilize Care Management — Ensure that tracking, reporting, and appropriate actions are taken and followed-up.
8. Improve Communication between doctors, hospitals, in and out of area. The ideal vehicle for this purpose is to have semantic and syntactic interoperability of information systems. But, when the medical record isn't computerized, the claim form must be as its surrogate.
9. Ensure Confidentiality - The aforementioned information may be shared in a confidential way, when that is medically relevant and necessary.
10. Cull the Chart, Take Out the Trash - It just makes things confusing to have bulky, disjointed medical charts with pieces here and there from the on-call doctor, lab, hospital, dentist, physical therapist, specialist - each of whom practices in a setting other than the 'medical home.' (It's time to consolidate disparate information, place it in the chart of the primary care physician.)
11. Create Competition In The Marketplace - Health insurance exchanges allow or foster informed choice of doctors and med/surgical services by patients and their families.
12. Compare Care and Costs of Care - Never again should being a woman or having had a C-section cause you to pay more for insurance coverage!

If we follow these 12 steps, we will determine cost savings within our new system. Of course all criteria -- cost, quality and access -- must be met, simultaneously, to have stability. Like a three-legged stool, with even one weak leg, our healthcare system will remain unstable.

Related Reading

Measuring and Managing; Managing and Measuring

Reforming Healthcare & Managed Care