We have (in the US) fewer and fewer primary-care physicians (50% of whom are in that rapidly aging boomer cohort) to make the patient centered medical home even happen (a commentator’s excellent point). Right now PCPs are struggling with EHR integration and expenses, and will do so for conservatively 12-24 months in their practice after adoption. Reimbursement for remote monitoring? Not even on the horizon. Are practices even thinking about altering their care models?
The other pressures are here. Despite–or because of–‘reform’–the healthcare system has become more expensive and confusing than ever, largely by expanding coverage in major directions and introducing a host of new ‘requirements’ with a slew of unintended consequences for the insured.
I just went through the adventure of finding a reasonably priced individual insurance policy, and I was shocked at the cost for close to ‘bare bones’, the rising rates and the lack of choice. (By explanation to those outside the US, our state of residence largely determines rates, increases and mandates inclusions; Federal ‘reform’ adds to them. There is no free market in insurance here!). In fact, if you are well, you pay more, not less (see the ‘bucket of cold water analysis by Heritage Foundation; you may disagree with their politics but it’s dead on). If you are fortunately well but older, you pay the same as if you had three chronic illnesses. If ‘reform’ was designed to lower rates, why all the talk of price controls? Latest news: McDonald’s suddenly non-compliant ‘mini-med’ plans may result in loss of coverage for 30,000 hourly workers, through no fault or flaw in the plans themselves. Our retirees are spending more on extended coverage plans (Medicare Advantage), and Medicare will be stripped for Medicaid coverage just as the ‘age wave’ hits the former.
Can this situation–more regulations, more mandates that are causing businesses to drop group insurance due to skyrocketing expense or compliance, seniors paying more–leading to universal capitation, payment on outcomes and ‘bundling’ of services–truly get us to the New Jerusalem of a transformed system that suddenly is able to intelligently organize medical care and integrate human carers into the latest technology for better, less confusing and affordable health and wellness for all? Or will the result at the end of a potholed road be a rationed, inefficient, bureaucratic system where expense is controlled by less quality care, insecure data, technology is considered ‘too expensive’ and eHealth thus never gets a foothold? (In other words, the US Post Office?) The patient centered medical home looks exceedingly far away. Your thoughts please….