In Part I “Unconnected Healthcare,” we discussed the many disconnections in healthcare today. In this article, we will flip the tables and discuss what the healthcare system would be like if it connected care to the patient at every step.

 

Complete Connection

 

Imagine if you will, a world where healthcare was completely connected to the patient. In this world, the goal would be to provide the  best healthcare at the lowest price possible. This would apply to doctors, hospitals, pharmaceuticals, regulators, and insurance companies.

 

This would greatly change our current system. It would still be a free-enterprise system, but with common goals and a complete twist to the existing priorities. In this world, everyone would all be on the same page trying to address the health of people.

 

Transparency

 

In this system, costs would be transparent.  I recommend a fix-cost system where the cost of the treatment or drug is the same to all people.  For those insured, the insurance plans could be simple. Perhaps the plans could be based on paying a certain percentage or nothing if the item was completely covered. the Those without insurance would simply pay the stated price.  However, a reduce price would apply for certain people with an inability to pay.

 

With information about costs, the doctor and patient could work together to decide on the direction of treatment.  The patient would no longer suddenly being surprised by overwhelming medical bills. Different facilities could charge different amounts, but all the information would be available to everyone. Thus, if a person’s heart surgeon is associated with two hospitals, they could choose the one with the lower cost.

 

Saving Money

 

The insurance company would save money by not attempting to overturn every decision that a doctor made (okay, a bit of an exaggeration). Instead, they would trust the expert who is familiar with the patient’s case to make the best decisions for the patient. The insurance companies would run periodic audits on doctors and healthcare facilities to ensure that they are treating appropriately. This would be a win-win for the doctors and the insurance companies, not to mention the patient.

 

Likewise, hospitals would drive decisions based on doctor’s recommendations for the patient rather than some government goals or regulations. Thus, if the doctor thinks  a woman who has recently given birth needs to stay a couple of extra days, they would make that decision.  No one would need to jump through hoops and hope for approvals to make it happen.

 

Flexibility

 

Additionally, the ability to get medication would be made easier. The total amount available would remain the same, but if you needed medicine two weeks before you ran out, you could get it. The date of the next refill would remain a month or the specified interval after it would have been if you filled it on time. Thus, if the refill is due on the first of the month, it would remain the first of the month for the next refill no matter when you last refilled it. In this case, trust is shown that the patient will use it appropriately. If they do not, they may run out or have other issues, but that is a separate issue that should not be managed by limitations on all patients.

 

Finding Cures

 

Lastly, pharmaceuticals would have incentives to find medicines that cure rather than manage symptoms. They would also be encouraged to look to natural methods and ingredients rather than just focusing on chemical combinations. There would be a focus on limiting side effects.

 

And, companies would not advertise directly to the consumer except in a limited manner for over the counter drugs. This would drastically cut the cost of drugs in two ways. First, the pharmaceuticals would have far smaller advertising budgets. Second, fewer drugs would likely be prescribed since people wouldn’t constantly be told “Ask your doctor if . . . is right for you?”

 

Changing World

 

If all goals were in support of the best quality of care for the patients at the lowest possible cost, many things in the medical world would change. Board of directors would even have a different view on executive salaries. There would no longer be multi-million dollar bonuses to hospital executives that cut cost at the expense of the patients. Instead, patient and staff feedback would drive the business, including bonuses to executives.

 

In a world where all healthcare is connected to the patient, everyone wins!

 

 

 

 

I have been considering what is at the core of the issues that we have with the healthcare industry. One of the issues that comes up over and over again is the lack of connection between patients, doctors, nurses, insurance companies, hospitals, etc.

 

Healthcare roles are complicated and many healthcare workers are overworked. Thus, it is not surprising that many healthcare workers don’t understand a lot about other aspects of healthcare outside their specific role. However, that puts the patient in the position of handling their own healthcare inside a system that is full of flaws.

 

Flaws  In The System

 

The flaws in the system start with the paperwork, where the same information is entered over and over. Then, you talk to a nurse or medical technician, who asks you all the same questions. They may or may not enter it into the computer at that time. Now, enter the doctor who asks at least part of the questions again. (And, they wonder why people have high blood pressure.)

 

It make sense to double check some things or verify things where the answer is unclear. However, it makes a patient wonder why they are filling out the forms. Of course, it is sometimes far easier to ask the patient the question than read their handwriting or find the answer among the general history questions that have nothing to do with the problem at hand.

 

Best Interest In Mind

 

Still, I believe doctors and their staffs generally have the patient’s best interest in mind. They prescribe the treatments, surgery, and medicines that they believe will help the patient. The issue is that they have no idea how much these treatments cost the patient. I would really hate for them to make decisions on treatments based on cost. On the other hand, when there are two viable options, the doctor could choose a less expensive option if they knew the cost.

 

Whose Interest In Mind?

 

Hospitals, on the other hand, appear to be focused solely on making money. Patient care is a statistic to meet a government guideline or rule. They are worried about being penalized and/or meeting requirements that are financially beneficial to them. Often these rules are contradictory and not aligned with providing the best patient case despite that being the supposed goal.

 

The pharmaceutical companies and pharmacies also play a role. The pharmaceutical companies decide what to research and how much to charge for the drugs that they create. Like hospitals, they are about making money, which is not a good thing for the patient. They search for ways to address symptoms rather than cure diseases because they have no incentive to find cures.

 

The pharmacies, along with government regulations, decide when you can get medicine that is prescribed to you. The rules are different for mail pharmacies and local pharmacies. In the case of local pharmacies, often you cannot get your prescription refilled until less than a week before you run out. This is a huge issue for patients when living in rural areas where it is miles to town or when someone travels. It is not uncommon in these situations for the patient to be required to take extraordinary steps to get their medication.

 

Codes, Codes, And More Codes

 

Now, enter the insurance companies whose goal it is to limit expenses. They question everything, but generally speaking the staff questioning the need for treatment has little if any medical training. They know nothing of the patients’ situation outside the “codes” and they don’t trust the expert’s opinion.   Thus, someone completely unconnected to the patient and their situation is attempting to alter or limit the patient’s care.

 

This is a recipe for disaster. Unfortunately, it means lots of time and dollars are wasted arguing about how much money is going to be spent. The patient, in turn, ends up spending time getting it figured out or making sure that someone is figuring it out. In many situations, the prescribed treatment is approved, but at what cost?

 

In Part II “Connected Healthcare,” we will discuss an alternate healthcare system that connects care to the patient at every step.