How to Lower US Sick Care Costs

How to Lower US Sick Care Costs

If you are reading this, it is likely that you are furious about the cost of care in the US, opaque pricing, exhorbitant out of pocket expenses, unaffordable health insurance that leaves you holding the bag or a bankruptcy declaration anyway and maddening care and billing experiences and service.

When it comes to medical debt, the US takes home the cake. A recent academic study found that 66.5% of all bankruptcies in the US were tied to medical issues — either because of high costs for care or time out of work. The research, which was published in the American Journal of Public Health, revealed that an estimated 530,000 families turn to bankruptcy each year because of medical issues. While some other industrial nations have health insurers, most avoid five-figure medical bills as a result of how insurers and doctors are regulated.

The US spends more than any other country because our prices are so high. Insurance costs more because our prices are so high. Our prices are so high because the system is not designed to restrain them and, consequently, there is no Moore's law for sick care services. Simply put, there are too many people benefitting from feeding from the $3.7T trough and none of the stakeholders want to say no.

We are intrigued by shiny new objects but ignore their costs. Will any of these reduce your insurance premium? Who going to pay for the future of medicine and how much?

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What's the answer? There are two fundamental strategies in play- more centralized, government regulated payment, providing and pricing or market based solutions, or , some combination of a public and private system of systems.

Sick care is a wicked problem and, therefore, requires a systems engineering solution. Those should include:

  1. More value transparency about quality and price.

  2. More patient education about data literacy and how to shop for care by raising their health and insurance IQs.

  3. Empowering patients to change doctors without having to pay high tangible and intangible switching costs.

  4. Data interoperability and portability.

  5. Reforming medical education to include competencies in practicing the business of medicine and knowing what things cost and how to create and measure value.

  6. Eliminating unnecesary , ineffective treatments, waste and abuse by monitoring physician prescribing habits and "rehabilitating" them.

  7. Rethinking the CPT and relative value pricing system.

  8. Mandating cost effectiveness analysis for payment approval with better collaboration between the FDA and the CMS.

  9. Let Medicare negotiate prescription drug prices.

  10. Don't recommend preventive interventions for seniors, like the shingles vaccine, that Medicare won't pay for.

  11. Balance the Medicare fund by means testing contributions and benefits and/or, raising the eligibilty age from 65.

  12. Better use of data and clinical decision support to create a care pathway cost estimate before proceeding with non-emergent care. Think what it will cost to build your Ford before dealer discounts online.

  13. Informing patients about doctors who are dead, retired or out of network or, who refuse to see them because they won't make as much money as they would taking care of someone with better insurance or who are willing and able to pay cash.

  14. Removing the costs of unnecessary administrivia.

  15. Train the workforce of the future, unbundle primary care and migrate sick care to healthcare.

  16. Using finsicktech technologies to reduce the 30% administrative costs of Sickcare USA.

Even these ideas will fail if we can't translate them into lower costs and deal with the intended and unintended consequences of the changes.

The US sick care system of systems is an unsustainable house of cards that is collapsing. Someone needs to call a doctor. Too bad there are so few willing to take new patients.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on [email protected] and Co-editor of Digital Health Entrepreneurship.

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  • Brian Sutherland

    It’s imperative for all of us to be involved and informed on the issues and hold sick care leadership accountable

  • Kane McClimon

    Americans have little faith that the government will find a solution to high health care costs

  • Ben Barnes

    There’s a lot of momentum behind the status quo.

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Arlen Meyers, MD, MBA

Healthcare Guru

Arlen Meyers, MD, MBA is a professor emeritus of otolaryngology, dentistry, and engineering at the University of Colorado School of Medicine and the Colorado School of Public Health and President and CEO of the Society of Physician Entrepreneurs at www.sopenet.org. He has created several medical device and digital health companies. His primary research centers around biomedical and health innovation and entrepreneurship and life science technology commercialization. He consults for and speaks to companies, governments, colleges and universities around the world who need his expertise and contacts in the areas of bio entrepreneurship, bioscience, healthcare, healthcare IT, medical tourism -- nationally and internationally, new product development, product design, and financing new ventures. He is a former Harvard-Macy fellow and In 2010, he completed a Fulbright at Kings Business, the commercialization office of technology transfer at Kings College in London. He recently published "Building the Case for Biotechnology." "Optical Detection of Cancer", and " The Life Science Innovation Roadmap". He is also an associate editor of the Journal of Commercial Biotechnology and Technology Transfer and Entrepreneurship and Editor-in-Chief of Medscape. In addition, He is a faculty member at the University of Colorado Denver Graduate School where he teaches Biomedical Entrepreneurship and is an iCorps participant, trainer and industry mentor. He is the Chief Medical Officer at www.bridgehealth.com and www.cliexa.com and Chairman of the Board at GlobalMindED at www.globalminded.org, a non-profit at risk student success network. He is honored to be named by Modern Healthcare as one of the 50 Most Influential Physician Executives of 2011 and nominated in 2012 and Best Doctors 2013.

   

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