Imagine if your doctor — before prescribing a drug or ordering a scan, lab work or some other kind of test — was prompted by a computer screen that told him whether his diagnostic or treatment plans aligned with medical evidence for best health outcomes, and then gave him the choice to change his mind and, potentially, your well-being.
Or, if Medicare — with its confusing, fragmented parts and differing premiums and deductions for hospital, outpatient and drug care — were collapsed into one health plan like private ones. Suppose Medicare no longer reimbursed doctors and hospitals based on a specific formula for certain services, but paid on performance, while consumers were given discounts for choosing health providers who worked in teams to provide patient-centered care, improving coordination among multiple providers.
The initiatives are part of a strategy recommended by The Commonwealth Fund, a private foundation based in New York and Washington, D.C., that is working toward a high performance health system. At a symposium for journalists last week in New York, foundation leaders highlighted brokenness in the system and ways to fix it.
In fewer than nine months, on Oct. 1, the country, under Obamacare, is charged with being ready to enroll Americans without health insurance in expanded Medicaid plans or private plans offered through online exchanges, which will be operated by the states or the federal government.
Jan. 1 is the effective date for the biggest mandates under health care reform: All individuals are required to have insurance; employers with 50 or more workers must offer insurance or face penalties; and insurers no longer can deny people coverage for pre-existing conditions.
It's estimated the reform will give access to 37 million people — more than the number initially enrolled in Medicare and Medicaid combined. It will be a momentous time in our history to be sure.
Experts say the problem is we've done nothing to control health care costs.