What can patients expect after Health Reform?

Big changes are on the horizon for the health care system. Physicians are going to be paid increasingly on the basis of outcomes of care, as well as effectively managing their practice population as a group; for example for all of the patients in my practice with diabetes, what is the average blood sugar of the group and, thus, how good a job am I doing "controlling" the disease state "Diabetes" in our practice?  Less and less can physicians expect to be paid for doing more tests, ordering more x rays and CT scans, and seeing patients in the office more often.  Instead, we will have greater incentives to be available to our patients, to work more effectively as a health care team, to communicate with patients about their test results outside of office visits, and to encourage patients to contact us via e mails, text messages, or online video tools.

These changes will provide major challenges to all of us, and will pose requirements for changes not only for the health care team, but also for the patients.  Below are the 5 things that I believe will be significant changes from the patient's perspective, and will gradually assume a greater presence in physicians practices over the next two to five years:

1. Patients will not need to visit the doctor's office as often.
As primary care practices begin to function as Patient Centered Medical Homes, they will be paid through outcome incentives and on a "per patient per month" basis rather than fee-for-service, making it more desirable to do things in ways other than using the relatively inefficient doctor visit approach.  Followups will occur via e visits and online portals (see below) will allow transmittal and review of data such as glucose and blood pressure monitoring in order to make decisions about the management of chronic disease.

2. Prescriptions will be routinely refilled, and many new prescriptions provided, using e mail or text messaging.
For established patients, there will rarely be a need to come to the office for a prescription refill; rather, using e mail and electronic prescribing, this relatively mundane, administrative aspect of practice will become much more efficient for both doctor and patient.

3. Patients will be challenged to put increased emphasis on preventive practices.
Rewards will be provided to providers for practices that obtain high levels of immunizations, recommended exams, mammograms, cholesterol checks, etc.  This will result in much more focus on preventive practice by your physicians.

4. Interaction with physicians offices will increasingly be through online electronic portals that are connected to the electronic medical record.
One of the primary reasons this method has not taken hold sooner is the lack of payment for it, forcing providers to funnel their patients into office visits in order to make a living themselves.  With the reform methods in the works, these perverse incentives will begin to disappear and the doctor patient relationship will be freed up to be what it should be, with free flowing communication independent of financial constraints.

5. Patients will be increasingly recognized as the drivers of their own health care.
The Participatory Medicine movement challenges patients to recognize that they, not providers, are the drivers of their own health, and to take control of this through acquisition and monitoring of their own health data and by obtaining the information they need to become, and stay healthy.

These are major changes that will not come overnight, but in order for the health care system to avoid bankrupting the country, and to begin to eliminate the billions of dollars spent on medically unnecessary care, they are sorely needed.

Your comments, questions and dissenting opinions are always welcome.

Working Together to Create an Affordable Health System

As we approach the presidential election next week, health reform is front and center as a key issue for the US. Entitlement programs, liability concerns by professionals, broad insurance coverage plans, and patient requests for expensive care have put the country on an unsustainable course that threatens us financially.

Many of the ideas for health reform, including encouraging more comprehensive primary care through patient centered medical homes, bundling payments to providers, and reclaiming money paid to hospitals for unsatisfactory outcomes are nibbling at the edges of what needs to be done.

But I can envision a radically different system from the one we currently have, one that centers on effective partnerships between professionals and patients in which the focus is on the issues that are truly necessary and really make a difference.

Here listed is a few of these:

• A commitment to nutritional balance and appropriate calorie consumption
• Regular exercise
• Avoidance of smoking
• Moderation of alcohol consumption
• Regular preventive visits to the doctor, using published guidelines for testing
• Commitment to careful control of blood glucose for diabetics
• Patient commitment to blood pressure measurement and adjustments necessary to achieve control.

Finding a physician who will lower the barriers to care, communicate easily and effectively with you to help you answer your questions, and provide guidance as needed is another crucial step in the effective, efficient health care system of the future.  

There is currently a growing shortage of primary care physicians, especially those who are open, innovative, and willing to maintain these types of patient relationships.  An essential part of the effective health reform of the future will require addressing the need to train these additional primary care physicians.  

Far too much effort, attention, and money is currently being spent on unproven or ineffective strategies and far too little is directed towards the outcomes in the bulleted list noted above.  Hopefully, this discrepancy will begin to be increasingly noticed and will start to be addressed.  

The answers to our un-affordable health care lies not in personalized medicine and ever more expensive procedures but in focusing on the basics of health and building a system around keeping Americans adherent to those principles.

Your comments or dissenting opinions are always welcome.