The future of United States healthcare

Healthcare in the United States is no longer focused primarily on care provided at the point-of-service. It now requires a broader perspective, such as a focus on health promotion, population health and individualized approaches. The main goal: Improve health outcomes.

SchmidtThis issue’s cover story focuses on “Health Plans of the Future,” and how plans need to change their priorities to keep up with the changing industry. An important part of this discussion, however, must include all the major healthcare players-providers, health systems, health plans, and consumers-and focus on how all must work together to improve the quality of the U.S. healthcare system.

To achieve a future where health outcomes are paramount, we need to stop concentrating on aspects of the system that have nominal impact and start implementing key drivers of improved outcomes. For example, focusing on the administrative costs associated with health insurance (not insignificant but not a driver of long-term outcome improvement), or interstate sale of health insurance (de minimis impact at best), will not dramatically impact the cost curve or the outcomes of care.

In addition, a dialogue about the drivers of cost in the current system must be considered.  Oligopolies in delivery, pharmaceuticals, and devices are key factors in the cost discrepancies between the U.S. and other developed countries. While healthcare spending in the U.S. far exceeds other high-income countries, health outcomes are lagging, according to a 2015 analysis by The Commonwealth Fund.

But there are pockets of innovation that can be the leading edge of transforming the U.S. system.  Some of these include:

• A growing emphasis on pay for outcome rather than pay for service.

• The public-private partnership of Medicare Advantage-a process where government sets goals, but private companies compete for membership and use different techniques to control outcomes and cost.

• The changing culture and training of providers that looks more to root cause and long-term outcomes.

• A shifting focus from hospital-based care to care provided in alternate settings-addressing palliative care needs and end-of-life issues.

• A growing emphasis on “whole person” care integrated with mental and physical health.

Some of the factors that may contribute to progress include:

• Technology gains in many areas, such as patient monitoring and surgical procedures, that lead to better outcomes and lower costs.

• Greater understanding of genomics leading to more personalized and hopefully, cost-effective treatments.

• Continued gains in understanding brain function and its effect on health status.

• Growth in destination medicine (highly focused sites with best practice results and efficiency).

• More acknowledgment of the psychosocial aspects of care and recognition of their impact on cost and outcomes.

To achieve this brighter future, several things are required:

• The public and the participants in the system must educate themselves to the underlying drivers of costs and outcomes including social determinants of health.

• We must acknowledge that the status quo is not viable in the long term.

• The government in and of itself should not be considered the savior or the ultimate villain, but a key factor in the evolution from healthcare to health outcomes.

David Schmidt, a Managed Healthcare Executive editorial advisor, is president of the TPG International Health Academy, which hosts trade/study missions around the world for U.S. healthcare executives. He also provides strategic consulting to health plans and health systems.