The world is witnessing radical healthcare reforms across nations what with ageing population and chronic illnesses infecting major segments of the population. It is not an exception in the US as well. It is supported by the fact thatapproximately 75 per cent of Americans in the US above the age of 65, suffer from chronic diseases. Additionally, three-fourths of the total US$ 2.4 trillion healthcare spending in the US is towards chronic diseases. (1)
What we witness today is a lack of proper coordination among hospitals, patients and caregivers. While doctors work independently, they are unable to communicate their needs with the hospitals, at the right time, and patients too, avoid going through regular checkups at the hospitals. This results in an influx of emergency patients in hospitals.
However, with ObamaCare, the stress is less on the footfalls recorded in the emergency units of a particular hospital or the number of procedures performed by them, as a measure of its efficiency. Rather, what is more important for healthcare evolution is how well they can address the overall healthcare needs of a target population. The need for such a system is more relevant in today’s world of increased HIV/AIDS, cancer and other paediatric disorders, which require preventive medication and outpatient treatments rather than emergency admissions.
Hence, what the future healthcare system would witness, is disease prevention, rather than last minute treatments.
Consequently, a paradigm shift is witnessed in the US healthcare systems under the Affordable Care Act:
• American doctors are increasingly shifting from independent practices, to salaried positions in hospitals.
• Non-profit hospitals are merging with bigger entities to work as a team in providing better facilities to the public.
Speaking on the first point mentioned above, John Graham, Director, Healthcare Studies Program, Pacific Research Institute, San Fransisco, said, “It (ObamaCare) is putting medical providers in hospitals, nursing homes, and other areas under government control, and having them deliver their service according to a very centralized system. That system will probably demand a high level of unionization or quasi-unionization and drive out private practice.” (2)
A case in point for the second statement discussed above ,is the merger of the SwedishAmerican Health System with University of Wisconsin, Maryland, which has been announced recently. Speaking on the plans, Dr. Bill Gorski, President and CEO, SwedishAmerican, said in a recent release, “By becoming a valued part of the world-class UW Health system, we are excited about what the future holds, despite these uncertain times. The Rockford region, as well as people throughout northern Illinois, will have greater access to the breakthrough research, advanced medical specialties and community health initiatives that earn UW Health national recognition.” (3)
This statement largely hints towards the changing healthcare scenario in the USA, post the Affordable Care Act.
Under ObamaCare, a new concept is being implemented – the Accountable Care Organisation (ACO). Itaims to better cost-to-value structures in the healthcare sector in the USA USA. Under ACO model, a group of healthcare providers - physicians, hospitals or specialists, work in close tandem with each other.They are collectively accountable for the cost and quality of care that is delivered to a patient population.The most significant contribution of the Affordable Care Act in creating ACOs is the fee-for-service model. (4)
Healthcare systems, to cope with the change, need to move away from the fee-for-service model. Earlier, healthcare providers used to earn more from affected patients. They took the patients through regular hospital admissions and repeated surgical procedures.
Reformers often call this “perverse incentives”. While hospital resources are over-utilised, patients are drained of their monetary resources as well.
This in turn means that doctors fall back on hospital resources over and over again. Naturally so, as doctors try to cure the immediate needs of the patients rather than improving their overall health, resources are over utilised.
A natural shift from the fee-for-service homes would be the PCMOs. These units provide patients with a primary caregiver, along with a team of medical supervisors who can better address chronic illnesses of different patients, at any point in time. PCMOs have been widely endorsed by health professionals across the globe. The basic characteristics of PCMOs are
Conclusion
The ACO and the PCMO combined with the Population Health Management systems would jointly and more cost effectively able to monitor disease prevention and management within a target population. They can support each other and work together as a unit to function as successful care providers under ObamaCare.
They can support each other and work in tandem with each other to function as successful care providers under ObamaCare.
