Healthcare Systems Fail Chronic Care Management

Part 2

Chronic Care Management is the future of care for those stranded between acute care and hospice.  The question is not whether the systems need this solution, but if the systems will embrace a new model.  The healthcare delivery system in this country is plagued with a disease that will lead to certain death. 

Today’s healthcare system is broken primarily because of the compensation model.  Physicians are paid for activities and not accountable for outcomes.  Their billables are what make them an asset to a health system.  This model ensures lots of action without care for results and certainly no patient follow through.  Furthermore, clinics are not held to the same standards of any other industry for service levels.  This goes against the constructs of free enterprise.  When the consumer does not have the option to choose a better provider of service due to the confinement of a network contract, the fierce competition for patients is eroded.  This would cause Adam Smith himself to roll over in his grave.  Finally, hospitals are filled with the remainder of the clinical community that have the credentials to work in healthcare, but not the influence to live and work in the better part of the sector.  In short, you don’t ever want to go to the hospital, but certainly not over the weekend when the lowest of the care community is on the clock. 

So, if healthcare is so broken, why wouldn’t the care community stand in line for a different model?  There are three reasons for such a dilemma that we should consider. 

 

1. The decision makers are afraid to rock the boat and put contracts, subsidies, rebates, and revenue share at risk.  People’s health is all about money and the healthcare establishment is proof of this reality. 

2. Avoiding public relations nightmares is the way to stay on top of healthcare.  One doesn’t stay on top with exceptional care and outcomes.  You stay on top through revenue and risk avoidance.  Anything we propose that is new and innovative is contrary to the core strategies of healthcare organizations and provides a risk that is too big of a pill to swallow. 

3. There are so many outsiders that have their hand in the pot of healthcare dollars that any system changed could bankrupt the wealthiest one-percenters.  Brokers, board members, shareholders and politicians all rely upon the cash machine called the healthcare delivery system.  The money shoveled to these few is one reason for the rampant increase in premiums to employers and employees all over the nation trying to find affordable coverage.    

 

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If we are to change the face of healthcare and enjoy its survival in the future, we have to push for change.  Change in this industry comes in the form of rewarding those on the edge of the care model.  Telemedicine providers, specialty hospitals, outpatient surgery centers, transparent service providers and open networks are great places to start sending your business.  The breakup of the giants will not happen through legislation, but through the free-market mechanism that is your checkbook.  Getting involved in politics and sending messages to our representatives informing them of our unhappiness with the imbalance between what is paid and what is received in healthcare is a great step toward change.  Finally, each person has to be willing to step up and make changes in the face of overwhelming resistance to that change. 

In the meantime, I will continue to try to breakdown the stone wall of resistance to change in the minds of the healthcare CEOs while you vote for change with your checkbook.  Together we can start a revolution in healthcare and maybe, just maybe, reverse the diagnosis of the healthcare industry.           

- MARK LEWANDOWSKI, PH.D., CM&AA     

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