The Future of Healthcare, Better Late Than Never
In healthcare, there are three qualities that generally define the effectiveness of a system. These are cost, quality of care, and accessibility (1). In our current U.S. healthcare system, healthcare 2.0, we are the most costly amongst developed nations (2), our accessibility has declined as the number of uninsured people has risen since 2015 (3), and the quality of our care ranks the lowest amongst developed nations. We can measure the quality of our healthcare system by looking at the average life expectancy. As of 2019, the average developed country had an average life expectancy of 82.6 years with each person on average spending $5,533 a year on healthcare expenses (2). In the U.S., our average life expectancy was 78.9 years with each person on average spending $10,949 a year on healthcare expenses (now up to $12,530 in 2021 as mentioned in my previous blog) (2). We ranked the lowest amongst developed countries when it came to our life expectancy, while ranking the highest when it came to the expenses of our healthcare, doubling the average cost compared to the average of developed nations (2). Does that sound like a fair deal to you? No, of course not, and yet nothing substantial has taken place to try and address this. There have been opposing sides of the argument, where there are those that think the U.S. government should step in and monopolize our healthcare system with a single payer system; with the hopes that the government will play nice and resolve these issues. Then there is the other side that believes that our current system should stay the way it is, as it should be, if we want to remain a capitalist country. However, there is a solution that no one seems to be talking about that can satisfy both parties. That is that we must reform the nature of competition, if we want to truly reform healthcare for the better of our capitalist country (1). The only way to do that, is if we can all unite for this one common cause. The solution I propose, is Healthcare 3.0.
Healthcare 3.0, as I’ve defined it, is a value based care system that empowers its patients to take ownership of their health, while incentivizing its providers to achieve exceptional outcomes. Now how do we measure value? Well as Michael Porter mentions, value is the measured outcomes of a cycle of care divided by the total cost of care (1). To put it plainly, if you achieve better outcomes with less costs to the patient, you have provided care that is more valuable than what others provide. Imagine that, a model of healthcare where the competitors (healthcare organizations) who win are the ones who produce the best outcomes with costs that are less than their competition. Well guess what, this isn’t just a fantasy I’ve made up in my head. There are already several organizations that have begun implementing this model. One example would be the Musculoskeletal Institute at the University of Texas. Under this model, their team of clinicians get paid more by their contracted insurance companies, if their patients have better outcomes, and they get paid less if their outcomes are poor. I believe this model of care will soon be a game changer once other organizations start to follow along. However again, we can’t expect this to happen if we don’t unite for this common purpose of providing more value to our patients; to everyone.
How is QOL playing a role in this? As a start, we will be focusing on providing more value to patients with non-traumatic (non-emergent) musculoskeletal conditions. How we plan on adding more value to our patients, is by providing a payment model that is clearly defined, and with the length of care clearly displayed. You pay X amount of money, for Y amount of time, and at the end, we will look at pre-treatment and post-treatment measurements to see how much value we provided you. From there we can take the average scores for each medical condition we see, and place those scores that each provider averages on display on our website (all of this data would be de-identifiable of course). That way, patients can make an empowered judgement call on whether or not working with the displayed providers is really worth their time and money. If this idea takes off, and becomes popular, we could see a healthcare movement like no other. People will be able to make informed decisions on which providers they want to work with, and the healthcare organizations will need to scramble to obtain the most valuable providers available if they want to stay competitive. What would this lead to? The best providers would see the most amount of patients, there would be a flood of innovation like no other to come up with ways to maximize outcomes while minimizing costs, and those organizations that don’t keep up will become an after thought.
This of course, cannot happen unless patients decide to take their business to places that provides the opportunity to take ownership of their health, and gives them the freedom of choice. This also cannot happen, if we do not educate the general public on these issues. There are also many people that just don’t know how they can realistically implement healthy decision-making into their day to day lives. This is especially apparent in those that are under-served and under-privileged. Which is why QOL created Community Day and Project Empower. Community Day will serve those that are uninsured and unable to afford our services, with pro-bono physical therapy services, which have been proven to be effective at improving pain and physical function of participants (4). Project Empower, is an initiative we created that will address gender and racial disparities that our current healthcare system faces, by empowering our youth to eliminate the barriers they face. We will look to accomplish this with a mentorship program for our local communities, provide educational events, and take part in other events that will give our youth, the tools they need to navigate the health and fitness industries (5).
“There is no power for change greater than a community discovering what it cares about.” - Margaret J. Wheatley
References:
Porter, M. E., & Teisberg, E. O. (2006). Redefining health care: Creating value-based competition on results. Boston, Mass: Harvard Business School Press.
Health system tracker: (https://www.healthsystemtracker.org/chart-collection/u-s-life-expectancy-compare-countries/)
Statisica.com: (https://www.statista.com/statistics/200955/americans-without-health-insurance/)
Stickler K, Sabus C, Gustafson H, Kueser M, Lavaveshkul B, Denney L. Pro-Bono Service Through Student-Run Clinics: How Does Physical Therapy Measure Up? J Allied Health. 2016 Fall;45(3):207-11. PMID: 27585617.
Begley K, Haddad AR, Christensen C, Lust E. A health education program for underserved community youth led by health professions students. Am J Pharm Educ. 2009;73(6):98. doi:10.5688/aj730698
