Friday, March 21, 2014

Health Reform Detour Signs

Detour, there's a muddy road ahead, detour
Paid no mind to what it said
Detour, oh these bitter things I find,
Should have read
That detour sign

Lyrics to 1945 Song, “Detour There’s a Muddy Road Ahead”

Detour signs dot the road to health reform.

·         The Obama administration is posting many of these with its  growing list of waivers, exemptions, delays, and postponements of employer mandates, and even the individual mandates for those with “hardships.”

·         The Republicans are unifying behind an alternative health plan featuring tax credits, enlargement of risk pools, expansion of health savings accounts,  transfer of Medicaid management to the states, and malpractice reform.

·         Physicians are detouring around traditional practices  by becoming hospital employees,   becoming leaders in large integrated health systems,   and developing new practice models.
Lately,   I’ve been focusing on these new practice models by interviewing  physician entrepreneurs who are shaping these new models.  

The new models include:

·         Specialty-led organizations that perform procedures – cataract centers,  endoscopy centers, imaging centers, orthopedic centers, heart centers,  non-invasive cancer centers.    Some of these centers,  like the Oklahoma Surgery Center in Oklahoma City,  take this alternative a step further – by posting their prices for everybody to see – and encouraging employers to send patients to the center rather to local hospitals.

·         Primary care- led organization who are creating new business models  based on variations of traditional practices.    Some of these new models are hybrids – combinations of traditional practices accepting 3rd party insurance with a superimposed  practice layer willing to accept  direct cash payments.    Other models are totally insurance free,  and depend on monthly or annual retainers, in exchange for quick access,  unlimited time spent with patients,  and  free or deeply discounted lab tests,  physicals,  minor surgeries, and medications.   Most of these physician models involve new relationships with patients,  employers, and health plans are designed to lower overall costs, including insurance costs.   In essence these new models  “unbundle” or “divorce” primary care from insurance-based care that involve hospitalization, expensive surgeries,   end-of-live care,  or other forms of catastrophic, palliative, or chronic care.

Tweet: A number of alternatives are developing  to detour around the muddied muddle of ObamaCare.

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