Healthcare reform will fail without reduced costs, realigned incentives, integrated care, and a focus on primary care and preventive medicine.
My previous post, "What Have We Lost and What Have We Gained with Healthcare Reform?”, part of the ongoing series “What's the Patient Protection and Affordable Care Act (PPACA) or ObamaCare Going to Do for Us?”, discussed long-term growth in healthcare costs and what can be done to reduce them.
Reform without cost-reduction and a realignment of incentives is a non-starter (I’m talking about reducing the level, not the growth rate of healthcare costs. We must also encourage greater integration of healthcare, for example with the "medical home" concept and the new appellation for managed care, the "accountable health care organization" (ACO). I recently discussed this with the CEO of a large academic medical group and he agreed, saying that “There has been no change in the fundamental structure of how care is delivered to make it more affordable, or to improve its quality. There continues to be an excess of hospitals, sucking up dollars, and stifling less intensive alternatives, and primary care, already in short supply is not dramatically increased. With 80% of physician services performed by specialists, a drive to move to 40%-60% primary care would bring access, preventive, routine, and chronic care maintenance into the system, reducing demands on high-cost, episodic, and isolated specialty care.”