Once again my mind is buzzing about the future of the healthcare marketplace and thus the future of medicine in the US after attending a talk last week on the topic. It gave great perspective on the financial tensions of our larger economic liabilities in the US and how that bottom line will shape the business marketplace and thus the context in which healthcare is delivered. I can have all my ideals about what medicine SHOULD be and the healing it SHOULD encourage (and I do!) but it is important to understand what is squeezing it and shaping it. And the reality of that is money. It goes back to a basic economic equation of Quality= Outcomes/Cost. Now some have realized that the patient experience is actually part of that, so the equation has been morphed to Quality= Patient Experience + Outcomes/Cost. So, the economic reality has direct impact on the context in which healthcare is delivered. Understanding that reality reinforces why an integrative approach to medicine (one that empowers each person to heal) truly feels ethically right and economically viable.
The main speaker was Michael Turpin, who gave a fantastic and entertaining summary of his healthcare marketplace perspective. I most appreciated the imagery of the Three Stooges: of Curly, Larry and Mo slapping one another. It can become a reactionary process of slapping the next person down the line when you need someone to take the blame or a place to release your frustrations. Has that happened with our $48 trillion underfunded Medicare liability? Are doctors and thus patients being slapped because if a much bigger dysfunctional family? Are we trying to balance an unequal equation? There are unintended consequences when we use a simple system to manage a complex one.
With the Affordable Care Act a reality, there is a shift and will continue to be a shift in the Marketplace that will greatly impact all of healthcare delivery. While most if it is restructuring due to cost and funding, that reshape will impact the services and mode. Mr. Turpin helped me understand a bit more the shifting liability of health insurance for employers. Now I can see how Health Care Reform can down the road have a domino effect on what actually defines health.
There is this whole concept of Exchanges for private or public health insurance. Employers are doing cost/benefit analysis of what their health insurance coverage will look like. What Exchange is most economical? No matter what, healthy employees are more cost effective. It seems the pressures of these Affordable Care Act do that passing of costs down like Curly, Larry and Mo pass the slap. More employers are going to become self insured. More and more groups of medical providers will be pooling resources into Accountable Care Organizations. They will be partnering up and turning to their employees trying to motivate them to stay healthy. There will be discounts for them if they do. We are starting to see it now, but it will be happening a lot more.
And that’s where we can move beyond the confusing hidden margins and manipulation of health care reform to what it should really be about. An Integrative Medicine (or LIVE IT Health) plan empowers each person in the seemingly endless cascade of slapping to reduce cost, to own their own better patient experience and outcomes. It’s important to voice and demonstrate that all parts of the equation benefit from an integrative approach to medicine. Performance incentives beg for an integrative approach to healthcare. Let’s make this transition an opportunity to shape a system that in fact nurtures healing and the best for each of us.
(for some laughter therapy, take a look at the ThreeStooges.)