System-wide changes in health delivery is an urgent and necessary task

System-wide changes in health delivery is an urgent and necessary task
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Today health care is not achieving its potential for individuals or the population as a whole. However, it seems that some large purchasers of health care are now ready to reject this model.

As a long-time advocate for older Americans and now leader of an organization representing health care providers, payers, and purchasers, I am increasingly optimistic that we can make significant progress, despite political gridlock.

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Three areas offer the vast potential for improvement: promoting prevention, strengthening chronic care coordination, and curbing prescription drug costs.

 

Unfortunately, our fragmented, uncoordinated system misses opportunities to improve outcomes and lower costs. What’s needed is a more holistic look at how to maximize health, both for populations and individuals.

In our current system, preventative care is too often foregone. Prevention services are underfunded and are often an afterthought for health care organizations focused on generously-reimbursed acute care services.

Our health care system just is not set up to manage the multiple chronic conditions many of them face, especially for the five percent of the population that accounts for fifty percent of the costs. It fails to help patients and their families navigate a complex, expensive web of coverage and providers. It fails to give actionable health and health care information to consumers.  

It fails to produce and empower sufficient numbers of primary care physicians who could better treat the needs of the whole person. Instead, our approach is to wait until patients must be rescued by skilled, but often uncoordinated and always expensive specialty and acute care services.

To add insult to the injury, prescription drug costs are rising as new, expensive drugs focus on narrow patient populations and prices climb for older drugs. No wonder that 31 percent of patients simply do not fill their prescriptions. Countless others never get their first refill.

Health care must change. We have to engage, empower, and treat the whole person, not just one body part at a time. We need health care professionals who can provide high quality care at reasonable costs.

We need care teams that include nurses, pharmacists, and mental health counselors as well as physicians. We need a system for tracking outcomes through electronic records so that we know what works and who needs follow up services. And finally, we need convenient care that is close to the patient and available to them on short notice and off hours.

In the private sector, the headline-grabbing commitment of Berkshire Hathaway, JP Morgan Chase, and Amazon, along with CVS Health’s proposed acquisition of Aetna, have real potential to shake up the system in ways that address these shortcomings.

Everything depends on execution. But if these new entities harness their purchasing power, their technology, their community presence, and their frequent interactions with patients, they can become the type of positive disruptors that actually walk the talk.

They can deliver on the promise of preventative, convenient health. They can advise patients on lower cost generic alternatives to brand name drugs. They can track medication adherence, reminding patients to keep current.

Moreover, disruptive delivery models like CVS Health-Aetna are working with primary care practices. This can help coordinate care and avoid harmful or unnecessary services for the chronically ill. This is the type of private sector innovation we need.

Moving forward with system-wide structural changes in health delivery is an urgent, national task. We will need stronger federal and state leadership—but amid today’s political paralysis, we can’t afford to wait for progress.

I will be the first to hold these private sector actors to account if they don’t deliver, but I will also be the first to applaud if they succeed. More importantly, patients and their families will finally start receiving what they need and deserve.

John Rother is the president and CEO of the National Coalition on Health Care and was the AARP’s Executive vice president of policy, strategy, and international affairs.