By Ron Ritchey, M.D., eQHealth Solutions
Now that the long nightmare of the government shutdown is finally over, it is likely that politicians will once again turn their attention to the #1 issue among voters in the 2018 midterm elections according to the Kaiser Foundation: healthcare.
When they do will it be more of the same – each side settling into their trenches, unwilling to give an inch if it means the other side gets credit for delivering something most Americans say they want? Or will they finally recognize that by working together everyone can win? Especially since both sides have essentially proposed the same fixes when given the opportunity.
We’re all hoping it’s the latter. But how do we get there? Here are three suggestions that can help politicians on both sides pull together and create a victory for all of us.
Game Plan For Cooperation Instead Of Contention
You don’t have to follow politics closely to recognize that many issues have become a zero-sum game for politicians. It isn’t enough to get what they want – they also have to make sure the other side gets nothing.
That’s a terrible way to govern – and an even worse approach to something as basic to the promotion of the general welfare as good health. What you end up with is a situation where if one side feels the costs of a proposal are too high or burden a particular group unfairly, they don’t suggest ways to solve those issues. They simply say “no” to the entire proposal.
The better approach is for both sides to look at the goal, then use their experience to find a way to make healthcare affordable and fair for all Americans. That’s why we elected them in the first place.
It’s obvious that there are no easy answers to making quality, affordable health insurance available to all Americans. If there were, the issue would already be solved.
But despite the way they are sometimes portrayed in the media, and the blogosphere, the U.S. Congress (as well as state and local governments) are made up of a lot of very smart people. If they quit butting heads automatically and instead use their collective brainpower to address the issues intelligently, there is little doubt they will develop solutions that will give all of us the healthcare we deserve without breaking the bank.
See The Entire Field – Populations
Focusing on a single player during a football game can cause you to miss the bigger picture of the game. The same is true with healthcare. Rather than viewing all healthcare as a series of individual encounters, over the last 10 years the industry has begun to understand the value of addressing healthcare for individuals through the lens of populations.
We now have powerful analytics that aggregate data about what has been successful with individuals so we can predict the approaches that are most likely to be even more effective in the future. We also have the capabilities to include factors such as demographics and social determinants of health (SDoH) to understand why what appears to be a well-designed plan of care doesn’t deliver the desired results.
We are making tremendous strides in learning how to motivate patients/members to become active participants in those plans of care. The net result is the growing ability to use population health management to personalize both the human and technical aspects of healthcare.
Yet despite all these advances, federal and state legislators still seem to think healthcare (and health insurance) delivery is the same as it was before the turn of the millennium. Their understanding needs to be updated to the current state – especially when it comes to the nearly unlimited promise new technologies offer for the future.
Think about the knowledge we have gained about the human genome, and the computer systems we have developed to take advantage of it by crunching the numbers on massive data sets. Every day we are acquiring new, deeper insights into serious diseases.
Also think about our recent advances in understanding human behaviors and how they affect our choices about healthcare and other important life decisions. Those insights can help providers and other caregivers become even more effective in offering assistance and guidance to those among us who bear the greatest disease burden.
Politicians can help drive those balls down the field by determining how to make the programs that are proving their value every day more affordable so they can be used more widely. For example, medical management and care coordination have been shown to have a huge impact on improving patient/member health outcomes while reducing the overall expenditure on healthcare. But to have those effects, they must be available.
If the dreamers and pragmatists will come together to understand what is working today in independent applications across the country, and to create solutions based on that evidence, those forward-looking politicians can enact changes that will benefit all of us.
Look Beyond Blocking And Tackling
Let’s face it: the easiest thing for politicians to do when the other side proposes a solution is to just say “no.” It also can be the safest and most expedient. But it doesn’t solve anything.
We the People have definitely sent the message we want healthcare and health insurance issues solved. Because if we don’t address the out-of-control cost of healthcare in a way that is meaningful soon, it could have devastating impact on the second-biggest concern among voters – the economy. It’s unlikely any politician wants to go into 2020 with failures in both of those areas on their records.
Clearly, politicians need to get more creative than they have in the past if they hope to solve these issues. One thing they can do is to take a cue from their health system and health insurance constituents and use some of the advanced predictive and prescriptive analytics that are proliferating throughout healthcare to understand how various ideas are likely to play out in the future.
In fact, they could collaborate directly with payers, providers, and other experts who are already running forward-looking scenarios. This will give them a better understanding of whether they will achieve the intended goals of various actions – and any unintended consequences that might go with them. With that information in-hand they can develop solutions that will work better within the current healthcare environment – or even improve upon the way healthcare and health insurance are delivered overall.
Score A Victory
Healthcare can no longer be a political football. Which means the time for partisanship and petty squabbles is past.
Instead, politicians need to start focusing on scoring real victories for all Americans. Otherwise, We the People will replace them with those who can.
About The Author
Ron Ritchey, M.D., is chief medical officer of eQHealth Solutions, a population health management and healthcare IT solutions company that touches millions of lives each year. The organization has more than 30 years of experience working with payers, providers, and government entities on increasing quality outcomes and optimizing payer and provider networks. He can be reached at firstname.lastname@example.org.