I received a letter from one of our Humana health plan members that was a valuable reminder to me of what the future of health care should look like from an individual’s perspective.
It’s always refreshing when our members take time to tell us not only what they find of value, but, more importantly, what else they need from us. While this letter focused on the positive, it was the letter’s theme that grabbed my attention.
Here’s a brief excerpt from the letter that I received from – we’ll call him “Joe”:
Dear Mr. Broussard,
I recently received the enclosed offer of an in-home Health and Well-being assessment and I wanted to thank you.
My wife and I (both Humana Advantage members) are both able to get to our doctors for our annual checkups (which are covered by our plan) but the in-home assessment for anyone less mobile is a great benefit.
We appreciate your push for Wellness programs and the periodic reminders help us with checkups, flu and pneumonia shots and the Silver Sneakers program and we participate in them all.
Joe’s letter was a terrific example of how a coordinated approach to primary care, prevention, and wellness can help people with their lifelong health journeys. It’s also a reminder that our combined efforts to create a healthier country have a long way to go.
For example, when people think of health care, they naturally think of how they’re treated when they get sick, not about how their coverage can help them get, and stay, healthy. This is further enforced by the fact that providers are paid for services they provide to patients, not the outcome of those services.
This raises several questions. Shouldn’t providers who work tirelessly to treat us when we’re sick be reimbursed for the overall health of their patients? If we keep expanding our efforts to get people healthy while rewarding them for making good decisions about their health, won’t that help reduce medical costs because we’ll have a healthier country?
A Challenged System
There is an inherent conflict in health care’s fee-for-service payment system, especially when it comes to cost.
Under fee-for-service, the more services doctors and other care professionals provide to their patients, the more they get paid. This system does not reward the doctors who achieve the best outcomes. As a result, depending on the provider, people might at times receive care they don’t need, and practices may vary widely among providers instead of the best practices being followed and quality of care being rewarded.
Fee-for-service has been the way much of health care has been run for a long time, but it should not be the way it’s run in the future.
It’s Here Today
Paying providers for practicing evidence-based medicine, optimal care for patients, and patient outcomes, sometimes called Accountable Care, has been around for some time. Notably, it’s been successfully used in Medicare Advantage, which is Medicare health plan coverage provided through private plans such as Humana that contract with Medicare and cover over 14 million Medicare beneficiaries.
The wellness and prevention activities Joe referenced in his letter play an important role in helping people improve their health under Medicare Advantage. Since we’re paid a flat fee for each member who signs up, we are incented to deliver the best care we can in an affordable manner. This is a challenge we welcome because we have a responsibility, obligation and motivation to do everything we can to improve the health and well-being of our members.
In addition, since Medicare Advantage is a competitive program that lets people like Joe and his wife choose coverage options from a wide variety of companies, the program has produced innovation, improved quality and lower out-of-pocket costs.
Paying for evidence-based medicine and optimal patient outcomes would also enable doctors to build long-term relationships with their patients so they can have a better understanding of what it will take to get people like Joe and others healthy.
It’s a Collective Approach
Health care is not easy. We make it complex, and it doesn’t have to be.
The solution to health care problems does not rest with one company, one industry or the government. We’re all responsible for the future of health care, from a doctor serving people through an Accountable Care relationship to people like Joe and his wife doing just what the doctor ordered: get, and stay, healthy.
If we want to reward providers for keeping people healthy in an optimal and affordable manner, not for incentivizing them to perform services, we also need to help people stay on the right path to health. These two parallel initiatives are tied together and make sense medically, operationally and financially. Everyone benefits from both of these initiatives.
In the end, we all share the same goal as our world-class provider community: let’s all work together to do everything we can to build a healthier country.
It’s time to go from sick care to health care. The rationale is simple: incentivize for best results and reward for smart decisions. It will take time, but it’s the right thing to do.
Photo: Mehmed Zelkovic via Getty Images