Affordable Healthcare 2.0

Those wanting an expanded governmental role and those opposing it are fighting the wrong battle in the wrong way.

The battle over a national healthcare policy has raged since the early 1990s. It has always been about coverage, liability, and finance, never about care protocols and patients. If making health affordable is everyone’s stated goal then why not focus on the actual care, health, and wellness of Americans?

America remains the best place on Earth to have an acute illness or shock-trauma injury. Our nation’s emergency rooms and first responder protocols are unequaled. Princess Diana may have lived had her car accident happened in New York City instead of Paris. America’s diagnostic methods and equipment are unequaled. That is why patients from all over the globe seek answers to complex symptoms by visiting the Mayo Clinic, the Cleveland Clinic, Johns Hopkins, Sloan Kettering and countless other world class facilities.

The other side of American healthcare is its failings in chronic care, expense, and a system that is controlled by the medical profession, pharmaceutical companies, and insurance industry. This triad of entrenched interests has prevented the widespread use of substances and therapies deemed effective and traditional in most of the world.

Thankfully, an increasing number of healthcare professionals are embracing global best practices, virtual technology, and patient-centric methods. These innovations are improving the health of patients while driving down costs. This is the arena where policy-makers should check their partisanship at the door. Seeking ways to improve healthcare, not health financing, will ultimately make health affordable to us all.

I have personal experience with the intersection of these worlds. Since 2007, I have been the primary caregiver to several family members with serious chronic conditions. These conditions have been punctuated by emergency care and major surgeries. Making decisions and managing treatment across this spectrum has been a real education. This education has helped me identify four major areas of opportunity for healthcare improvement.

Republicans, in particular, should take note of these four evolving areas of healthcare. They have made opposing Obamacare the centerpiece. Opposing the President’s approach does not solve anything. The American health status quo really does need to change. These four areas offer real opportunity to improve our health and healthcare, while addressing the affordability of private and public health services.

First, not all ailments require doctors and prescription medications. Herbal remedies have been effective since the first humans. For example Apple Cider Vinegar has completely solved acid reflex for two of my family members, but is not covered as a medical expense either by insurance or tax deductions. Instead, acid reflex sufferers must pay for over-the-counter treatments, which are also not covered by insurance or tax deductions, or get expensive prescriptions, after paying to see a doctor or a specialist. Being a natural treatment, the vinegar regime also avoids side effects and drug interactions. Why not go “back to the future” and find ways to support the use of more affordable and more effective treatments?

Second, nurse practitioners form one of the new front lines of care. Many times the overwhelming majority of my family’s office visits are with a nurse practitioner interacting with the patient and the lab technicians. The doctor arrives to review all the information and discusses treatment options with the patient. Supporting this evolution through education, professional certification, protocol modifications, and pricing would bring down costs and expand health opportunities both for professionals and patients.

Third, community caregiving is another new frontline of care. In 2009-2011, I was part of the planning team for developing a community-based care system for the Atlanta area. We found a disturbing pattern - patients, especially Medicaid patients, arrive in hospital emergency rooms when their chronic conditions, such as Diabetes, congestive heart failure, and Chronic Obstructive Pulmonary Disease (COPD), become acute. These patients are treated at the most expensive point of care (emergency room). Once they are released, many do not have the support (family, friends, neighbors) or the capacity (some form of dementia) to follow a treatment regime that would prevent the next emergency room visit. These revolving door patients drive up costs and end-up in a cycle of deterioration.

Our solution was to develop a community-based healthcare network. Such networks are known as “Accountable Care Organizations” (ACOs). They break-out from traditional hospital and doctor office environments to forge partnerships with the community – churches, social workers, local government, neighbor associations, and nonprofits. A needy patient with chronic conditions is assessed holistically. This includes risk factors (i.e. smoking, alcoholism, drugs) and environmental factors (family & home environment). A care plan is developed and assigned to a multi-faceted care team (comprising community resources) and a care manager. Doctors and nurses are part of the team. The majority of health actions take place among family and community - driven by Electronic Medical Records, aided by remote sensors and virtual care, and guided by the managed care team.

The result of this holistic approach is improved care, improved health, and reduced costs. It is the one way Medicare and Medicaid costs can be fundamentally and sustainably reduced while enhancing quality of life. There are initiatives to promote this within the Center for Medicare and Medicaid Services (CMS), but this is occurring too slow and is too isolated.

ACOs are making a difference, but no major politician has embraced the concept and neither party has promoted them as a way to reduce Entitlement costs.

Fourth, families have always been a pivotal component in healthcare. Whether it is a parent staying home to care for sick children, or adult children caring for ailing parents, family caregiving is vital, but also emotionally and financially draining.

According to the National Alliance of Caregiving, 70 million Americans provide unpaid assistance and support to older people and adults with disabilities. Forty percent of these caregivers provide care for 2-5 years, while approximately 29 percent provide care for 5-10 years. Unpaid caregiving by family and friends has an estimated national economic value (in 2004) of $306 billion annually—exceeding combined costs for nursing home care ($103.2 billion) and home health care ($36.1 billion). This value is increasing as the population ages.

I know how much time is spent with ailing family members. Current IRS regulations provide for listing parents as dependents based upon financial support. However, there are no tax credits or deductions for those who have the Medical Power of Attorney and devote countless hours to direct care or acting as the patient’s advocate for managing their care. Politicians at both the state and federal levels should provide relief for this vital and growing volunteer service sector.

These four areas of opportunity will not address every health issue or entirely diffuse the fiscal bombs strapped to entitlements, but they are a good start. It is time for politicians to focus on the well-being of patients, not themselves.