6 Strategies for Fixing the Broken Healthcare System
“The Strategy That Will Fix Health Care” is an intriguing and thought-provoking article published in the October issue of Harvard Business Review.
RNs have been espousing concern about the broken healthcare system for more than a decade now. Seasoned hospital RNs express how healthcare is at an all-time low. In 31 years of educating Certified Legal Nurse Consultants from all over the U.S., I have never witnessed more pessimism about healthcare and the climate of RN jobs in hospitals.
The premise of the article is that it’s time to maximize value for the patient, i.e., achieve the best outcomes at the lowest cost. The authors propose a patient-centered system (hardly a novel concept) with a strategic agenda of 6 components:
Organize into integrated practice units.
Measure outcomes and costs for every patient.
Move to bundled payments for care cycles.
Integrate care delivery across separate facilities.
Expand excellent services across geography.
Build an enabling information technology platform.
Are these ideas sufficient to get us out of what I call the “Dark Ages of Healthcare?” Probably not, because the healthcare system can’t get fixed until the insurance companies get fixed too. While I find it interesting that insurance companies weren’t directly addressed in the strategies, it’s at least refreshing to see that the conversation about the broken healthcare system and recommendations for fixing it are finally on the table.
And as for CLNC consultants, it’s unlikely that medical malpractice cases are going away anytime soon.
I’m Just Sayin’
P.S.Comment and share your thoughts, as a Certified Legal Nurse Consultant, on what it is going to take to fix the broken healthcare system.
3 thoughts on “6 Strategies for Fixing the Broken Healthcare System”
I don’t have any good answers as to what will fix the healthcare system, but I can definitely say what is not working. As a nurse working as a case manager for two different insurance MCOs (in one I managed commercial, Medicare and Medicaid members and the other I managed strictly Texas Star and Star Plus Medicaid), I found that the insured members needing disease management the most, didn’t want it. To be fair, most not wanting my help was the Star and Star Plus. AND, at least in Texas, it doesn’t matter how well we documented non-compliance of the member and most likely ER abuse due to drug seeking, Medicaid refuses to allow MCOs to terminate their benefits. On top of that, I recently discovered that women in Texas are able to sign onto the Texas Pregnant Women Medicaid just by claiming that they are pregnant, without proof (of course they must meet the financial criteria for Medicaid). Something is definitely wrong with the system when everyone BUT the patient is responsible for their own health.
It will be challenging when new patients who will not be paying as much into the system will be using more care than they pay for. What’s most challenging is that they expect top notch options and a full package at discount prices. My experience with socialized medicine has taught me that managed care prices gets you managed care, not endless options. And Americans will die for their freedom of choice! Just an observation I’ve noticed as a fellow American!
In my experience as a patient using the healthcare system, I have discovered that comparative shopping for healthcare services is impossible when providers refuse to disclose how much your healthcare costs. In fact, the relationship between your insurer, who negotiates your prices, and the provider is confidential so that the provider is protected from disclosing the negotiated price. Usually, you don’t know what you will pay until you get the bill. And then there’s the lab bill. And then there’s the radiology bill. And then there’s the anesthesia bill. And then there’s the pathology bill — two of them.
Where are the patient’s rights to know what we are going to pay before we buy? What other business expects payment in the thousands of dollars without an estimate?
In a capitalist system where pricing is structured on competition, there won’t be fair pricing until there is fair competition.
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*The opinions and statements made by Vickie Milazzo, the founder of Medical-Legal Consulting Institute, Inc. are based on her experiences and expertise, should not be applied beyond the specific context provided, and do not guaranty or project actual results. Vickie Milazzo is no longer involved in the operations or management of the business, but is involved as an independent education consultant.
I don’t have any good answers as to what will fix the healthcare system, but I can definitely say what is not working. As a nurse working as a case manager for two different insurance MCOs (in one I managed commercial, Medicare and Medicaid members and the other I managed strictly Texas Star and Star Plus Medicaid), I found that the insured members needing disease management the most, didn’t want it. To be fair, most not wanting my help was the Star and Star Plus. AND, at least in Texas, it doesn’t matter how well we documented non-compliance of the member and most likely ER abuse due to drug seeking, Medicaid refuses to allow MCOs to terminate their benefits. On top of that, I recently discovered that women in Texas are able to sign onto the Texas Pregnant Women Medicaid just by claiming that they are pregnant, without proof (of course they must meet the financial criteria for Medicaid). Something is definitely wrong with the system when everyone BUT the patient is responsible for their own health.
It will be challenging when new patients who will not be paying as much into the system will be using more care than they pay for. What’s most challenging is that they expect top notch options and a full package at discount prices. My experience with socialized medicine has taught me that managed care prices gets you managed care, not endless options. And Americans will die for their freedom of choice! Just an observation I’ve noticed as a fellow American!
In my experience as a patient using the healthcare system, I have discovered that comparative shopping for healthcare services is impossible when providers refuse to disclose how much your healthcare costs. In fact, the relationship between your insurer, who negotiates your prices, and the provider is confidential so that the provider is protected from disclosing the negotiated price. Usually, you don’t know what you will pay until you get the bill. And then there’s the lab bill. And then there’s the radiology bill. And then there’s the anesthesia bill. And then there’s the pathology bill — two of them.
Where are the patient’s rights to know what we are going to pay before we buy? What other business expects payment in the thousands of dollars without an estimate?
In a capitalist system where pricing is structured on competition, there won’t be fair pricing until there is fair competition.