THE SUPREME COURT HAS RULED, BUT WHAT REALLY MATTERS IS REFORMING HEALTH CARE DELIVERY!

The factious debate regarding the constitutionality of the Accountable Care Act (ACA) is over.  The Supreme Court has ruled that the law is constitutional, including the health insurance mandate which was judged to be a tax.

Health care reform will now be elevated to a major political referendum in the upcoming national election.  Virtually all agree that we need a health care system that is accessible, affordable, and effective in providing quality health care.  Whether the best route forward is through the ACA or other legislative-directed approaches is far less certain than the need to change our underlying approach to health care delivery.

We must move from our current reactive, sporadic approach, using expensive technologies to treat late-stage preventable disease-events to a coordinated preventive, personalized model of care.   Personalized health care addresses the specific health needs of individuals at any time in their life and utilizes predictive technologies to evaluate health risks and employs planning to provide the care most likely to be effective.  This approach to care is personalized, predictive, and preventive and involves an engaged and enlightened patient.  A great barrier to innovation in health care has been a reimbursement system that handsomely rewards high cost intervention for late-stage disease and punishes prevention and coordinated care.  Reimbursement models that reward successful outcomes will help unlock innovation.  As a consequence, personalized health care will be embraced by more and more enlightened providers, employers, and insurers.  So, while the heated debate will focus on legislation, the real work of resolving the problem will occur through fixing health care reimbursement and developing and adopting health care approaches that work.  There is a great degree of creativity being deployed to create the most effective models for care.  New technologies are enabling increasing personalization and are putting capabilities in the hands of consumers and lower cost providers.

With a more rational approach to health care, access and affordability will be attainable.  Absent changes in how care is delivered, health care legislation will do little more than drive up costs and add to the burden of an already struggling economy. The solution to affordable quality care is attainable but the solutions will need to occur outside the partisan health arena.

AVOIDING A HEALTH CARE BUBBLE

The recent report from the Department of Labor showing that the United States economy added just 69,000 jobs in May was met with surprise and disappointment and has had an immediate effect on the presidential campaign as well as the stock market.

What was lost in this news, however, is that almost half of the job growth came in the health care sector. Thus, health care provides a large underpinning for our economic growth, but is this a good thing? Currently, health care expenditures are quickly increasing beyond what individuals, employers, or the government can afford. Ironically, what is gained by these increases in employment may be offset by the burden of rising health care costs on the overall economy. This raises an important question. Is the expansion within the health care industry a good thing for our economy and nation or is it an emerging bubble that will inevitably burst?

Over the past decade, national health care costs grew from an already large $1.6 trillion per year and 14% of the GDP in 2002 to $2.6 trillion per year and 18% of the GDP currently. This growth has been fueled by increased costs of treating chronic diseases with expensive specialty and hospital care. Such expenses are driven in part by investments in technologies and new facilities which often rival the opulence of five star hotels. According to the Health Care Cost Institute, price increases and costs of hospital admissions grew nearly three times faster than inflation. Despite the drag on the economy from the rising cost of health care, preventable chronic diseases have continued to grow. Consequently, the increased expenditures have not led to an improvement in the health of the nation.

What is frightening is the parallel between the growth in the health care industry and the recent experience in the real estate market. In real estate, the American dream to own a home was seen as laudable. Unfortunately, the financial market could not sustain the growth of the housing market and it ultimately collapsed. In health care, access for all Americans is at least as important a goal and should be achieved, but it must be done in a way that is effective and affordable. The current approach, in my view, is neither effective nor sustainable. Fortunately, there is a solution to this dilemma. Health care expenditures must be focused toward health promotion, prevention, patient engagement, and coordinated care rather than the current emphasis on high cost, sporadic treatment of disease events which are largely preventable. We know how to make the approach to care far more effective and less costly.

Personalized, predictive, and preventive approaches, with intense patient engagement, are already proving to be far more effective than the current reactive treatment of disease events. At the center of effective care should be the individual (who at times is the patient) who is engaged, informed, and involved in their own health. Coupling the engaged individual with a health care system designed to meet personalized medical needs overtime is the model that we should move toward. Health care sector growth within a system that actually improves health and minimizes preventable diseases will be cost effective, sustainable, and a true boost to our economy. Absent this, growth in the health care industry is a mixed blessing.