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by Kent Bottles
It sounds so easy and logical. Uber disrupted the inefficient and poorly run taxi system. The Uber model should be able to successfully disrupt the inefficient and dysfunctional American healthcare system.
In a blog post titled “An Uber for healthcare is closer than you think,” Davis Liu, M.D. predicts the creation of software that “would allow anyone to access the expertise of the best doctors for diabetes, bladder infections or cancer care. ... Once this class of software is widely available to the public, then the Uber for healthcare will have arrived. People will discover healthcare can [be] super convenient, quick and easy, and inexpensive. Just like Uber.”
Investors have bought into this goal in a big way. Funding for on-demand healthcare has increased with a total of $692 million in funding since 2011, according to Rock Health. An Uber co-founder raised $14 million for the startup Pager, which makes physician appointments instantly and charges a flat fee for urgent care visits, physical exams, and phone consultations, notes a Forbes contributed post.
by Kent Bottles
To say there is a global disagreement about publicly reported ratings for physician and hospital performance is an understatement. The trend is toward more ways for the public to consult data before choosing a physician or hospital. In 2007, the National Health Service in the United Kingdom launched the NHS Choices website to allow patients to evaluate physicians and hospitals. In 2011, the largest German health insurer created the Arzt-Navi website with a similar function. Internet searches reveal more than 30 private physician-rating sites.
In the United States, there is general agreement that healthcare costs too much and that there are outcome-related quality difference between physicians and hospitals. If publicly reported ratings for providers can reveal these differences, they would be powerful tools that could support the Triple Aim and improve healthcare. Many of the provisions in the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act advocate for more transparency and accountability of physicians and hospitals.
by Kent Bottles
Last month I was so busy doing my income taxes and preparing MACRA presentations for conferences in Maine, Connecticut and Pennsylvania, I forgot to pause and reflect on the Affordable Care Act turning 6 years old on March 23.
What is the current state of the ACA? Will the next president repeal or replace the ACA? Is it a success or failure?
Each of the Republican candidates for the presidential nomination vow to repeal the most important healthcare law since Medicare was passed in 1965. Hillary Clinton says she will make changes to the ACA, and Bernie Sanders proclaims that he will replace the ACA with universal coverage. Before we predict which scenario we can expect in 2017, perhaps we should take stock of the current state of the ACA.
The two main goals of the ACA are to increase the number of Americans who have health insurance and to increase the value of the care they receive.
Recently I have been working with healthcare organizations in the Northeast Corridor—hospitals, physicians and ancillary services—helping them adjust to the seemingly ubiquitous consolidations of systems. In New Jersey, there may soon be two mega-systems: the St. Barnabus/Robert Wood Johnson merged system and the Meridian/Hackensack system. Approximately 65 percent of all inpatients will be absorbed by one of these two consolidations. For residents of New Jersey, that leaves only seven other hospitals. For ancillary service providers, this means they aren’t sure if they will be in business.
Similarly, in Connecticut, Yale-New Haven Hospital has been acquiring hospitals and physicians, causing a good deal of disruption for the remaining providers, confusion for consumers, and concern among home health providers, visiting nurses, special purpose centers and others.
Big consolidations are having big consequences
There is certainly no shortage of literature on the expected and unintended consequences of these big system integrations across the U.S. After the Affordable Care Act was passed in 2010, responses came slowly at first and then swiftly. The expectation was that there would be better patient care, improved care coordination and reduced overuse of services, if not lower costs.
by Kent Bottles
A major new study showing that hospital prices vary enormously between different American cities will impact the strategy of all hospital executives and call into question one of the theories behind the Affordable Care Act.
Aetna, Humana and UnitedHealth contributed data on the spending and utilization of 92 billion health insurance claims from 88 million Americans who have employer-sponsored health insurance.
"Virtually everything we know about health spending and most of the basis for federal health policy comes from the analysis of Medicare data," says Yale University's Zack Cooper, who is a co-author of the new study. "The rub is that Medicare only covers 16 percent of the population. The majority of individuals—60 percent of the U.S. population--receive healthcare coverage from private insurers. This new dataset really allows us to understand what influences health spending for the majority of Americans. This information is critical to creating better public policy."
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