Wednesday, June 4, 2014

The Power of the People and the Search for a Perfect Health Care Business Model 

Self-reverence, self-knowledge, self-control.
These three along lead life to sovereign power.

Alfred North Tennyson (1809-1892),  Aoenone

Everyone to whom I talk to these days has their own idea of a perfect health care business model, whether it be a single payer system or a free market solution or “something in between.” 

 That “something in between" is ObamaCare, which few seem happy with, mainly because few understand it,  resent its broken promises of keeping your doctor and your health plan, and most know only 40% of ObamaCare funds  go to directly paying doctors and hospitals.  Health plans, pharmaceutical companies, and the government bureaucracy consume 60% of the health care dollar.

Joe Grundy

Today  I spoke to Joe Grundy,  a 28 year MBA “delivery system strategist” for the American Academy of Family Physicians,  an organization representing  118,000 family physicians. It is the 3rd largest physician organization in the country,  following the AMA and the American College of  Physicians.  

Joe  Grundy’s  job is to keep an eye out for health system innovations that directly primary family physicians. These doctors are unhappy with their lot.    They consume only 6% of the total money spent on health care, yet they are the conduit through which most health care dollars flow. They are key entry points into the health system, but they are the low men and women on the physician income totem pole. 
Most observers say that without a robust pool of family practitioners you cannot have an efficient and humane health system.    There is no doubt family physicians do not get the respect for the value they bring to the system, nor do they  reap the rewards  they deserve. 

There are not enough of them.  In fact, the U.S. falls short of them by 50,000 or so, depending on to whom you talk.   They tend to be overworked.  Many suffer from burnout.  Among other things,  lack of these practitioners  and their rapid turnover may be partly responsible for the VA’s long waiting lists.

Joe Grundy’s job is to show the “value” of family physicians and what they bring to the table -  personal relationships with patients,   personal knowledge of their families and economic situations,  and their roles in prevention and  as the human hub of the health system. 

Empower the family physician, and you will empower the patient.  Given the advice of a personal physician,  most  patients will make the right  choices of how to prevent disease,  stay healthy, and remain solvent.

In any event, members of the American Academy of Family Physicians have shown an intense interest in ObamaCare alternatives, one of which is Direct Primary Care  (DPC).  Only about 1.5% of AAFP members are in DPC, but somewhere between 10% to 14% want to know more and are considering becoming DPC physicians so that they might spent more time with patients rather than dealing with 3rd party busywork,  practicing medicine,  and supplementing their income by doing what they are trained to do.

Stanley Feld

Enter Stanley Feld, MD, an old friend,  a 76 year retired endocrinologist and a vital and vibrant force in health reform. Stanley writes a blog entitled “Repairing the American Health System.”   In his blog, Stanley pulls no punches.  He thinks ObamaCare is a disaster on many levels and on many fronts – for patients, doctors, and the health system.  

But Stanley is not one to criticize without offering alternatives.   That said,  he has come up with an alternative system which he calls “My Ideal Medical Savings Accounts.”

Here is how he explains his concept in his blog.

"Medical Savings Accounts for our discussion are tax free trust accounts that are funded by the employer, the self-employed, and the government for the employee, or the Medicare and Medicaid beneficiary.  The Medical Insurance provided by the employer, the self employed, or the Medicare or Medicaid beneficiary in addition to the MSA trust is a high deductible insurance plan. The rating on the high deductible insurance should be community rating without exclusions for preexisting illness." 

“The deductible is $6,000. The MSA contribution will be $6,000. If the patient does not spend the trust accounts money in the current year that money accumulates tax free until retirement. In the case of Medicare the money accumulates tax free until used at the beneficiaries discretion or is deposited in the beneficiaries’ estate. At that time the rules for traditional IRA’s apply.”

“It is mandatory to have insurance and the premiums will be subsidized by the government for persons that qualify. Price transparency by the insurance industry, hospitals, and physicians is also mandatory. It is the responsibility of all parties to aid the patient to become an educated consumer. If they want to purchase an unnecessary or inflated medical care product it is their decision and not the insurance industry or government’s decision. The patient pays the inflated price and not the insurance industry and the government.” 

“This is the basic formula for the Medical Savings Accounts. It is important for this system of insurance not be contaminated by modifications made by stakeholders in order to benefit their vested interest. The formula creates a system of insurance that compels the patient to be an informed consumer. It also compels the stakeholders to be competitive for the patients’ healthcare dollar. “

To summarize,  Stanley’s idea is “More Power to the People.”  Inform them.  Educate them. Supply them with tax-free trust accounts.   Tell them upfront what their options are.  Be transparent with them.  Let them choose their own doctors and health plans. Let them shop across state lines.  The people’s health is directly  up to them with their doctors’ help – not to government or the insurance industry.

Tweet:  The American Academy of Family Physicians and others are in search of a health system business model based on people’s use of their own money choice of  physician.

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