Value Based Payment In Health Care

I spent over 5 hours the last 2 days at a medical-legal educational meeting.  One of the big topics discussed was the changes coming in the near future in the health care system.  The largest change, I believe, will be the shift to value based payment.

In the simplest terms, value based payment refers to paying more money for better care.  We already have some elements of value based payment, with Medicare requiring doctors to show that a certain percent of their charts have the patient’s smoking status and medications and vital signs documented.

These bureaucratic and record-keeping requirements are just the beginning.  Rather than just showing that we’re asking the right questions and documenting properly, we’re soon going to be required to prove we’re providing better care.

How do we define “better” care?  Simple.  Less expensive care is better care.

With the development of accountable care organizations, or ACOs, big aggregates of health care decision-makers are going to be receiving insurance premium money directly.  If they can provide good health care to those they insure for less money, they get to keep the difference.  If not, they may go out of business.

On average, the insurance companies know how much it costs to provide health care to a given individual.  So if an ACO in northern Ohio is able to get 100,000 people to enroll, it’s just an actuarial exercise to figure out how much money they need to charge each person.

That ACO not only has people experienced in the insurance industry but also generally includes a hospital system or network (who provides the care, like labs and Xrays and hospital-based care) and a pool of medical providers (who direct the care).  (The ACO system is based on the Kaiser Permanente model of care, by the way.)

Let’s say our ACO gets 100,000 people to enroll and collects their premiums.  If the ACO is able to provide these people good care for 80% of the money they collected, they’re doing great and probably would be able to lower premiums for the next year.  That will make the ACO very attractive and more people will enroll.

(What happens if the ACO gets TOO focused on the bottom line and decides they can save more money by providing crappy care?  Well, the simplest thing that will happen is people won’t re-enroll.  They may also be open to lawsuits, but let’s keep it simple and assume that in the interest of keeping the business open they won’t want to provide crappy care.  It’s a balancing act between saving money and keeping customers happy.)

By keeping health care decisions, implementation and payment under one roof, so to speak, ACOs are able to simplify the care experience for patients.  This makes it easier to experiment with alternative care models like telemedicine or remote monitoring.

Value based payment means sharing the money saved with those who made the decisions that saved the money in the first place.  Doctors, hospitals, pharmacies and others have roles to play in helping to hold down the cost of health care. Profit-sharing arrangements benefit everyone:  doctors and hospitals make more money, customers get lower premiums, and the ACO gets more customers over time.

By finding ways to keep patients healthy, to keep minor problems out of emergency rooms and head off illnesses before patients wind up in the hospital, and by developing innovative ways to help patients manage chronic conditions, ACOs are well positioned to help decrease costs.  And by using market forces (like price, profit and customer experience) to drive changes, this will work much better than top-down legislative changes mandated by the government.

Why are we discussing ACOs and alternative care models and changes in our health care system?  Simple.  We can’t afford the system we have now.  With a growing elderly population and a ballooning national debt, increasing numbers of people receiving health care with government subsidies (through Medicare, Medicaid, the VA, and tax-subsidized exchange plans), our system is broken and must be fixed or our country will go bankrupt.

We have decided as a nation that everyone must have health insurance.  We can debate the pros and cons of Obamacare but it will not be repealed.  It is the law.  Other countries have decided that the best way to provide health insurance to everyone is to have the government provide it (i.e. single payor).

Private industry is America’s strength.  Innovation and pure scrappy entrepreneurship have solved more problems in our country than the government ever could.  I believe this is a very exciting time in American health care.  Lots of people have a gloom-and-doom outlook, but I don’t.

I think America is putting her best and brightest to work on the problem and coming up with a uniquely American solution that reins in the cost of healthcare while it respects American values of independence and autonomy.  This problem will not be solved on Capitol Hill or in the White House.

America gets market forces.  True solutions to the problem of funding health care must be driven by market forces, because as much as the government might wish otherwise, health care is a business like any other.


What To Do When You Overdose On Sugar

Happy Easter everybunny!  How did you do?  Did you have too many jelly beans or other sweets?  We sure did!  My family and I are just getting back from a wonderful Spring Break trip and boy did we overdose on sugar this week.  Ugh!

I noticed a number of symptoms from the sugar overload.  These are symptoms that I usually get when I overdose on sugar and they are typical warning signs.

1.  Joint pain

High sugar intake causes inflammation which will make your body hurt.  I noticed that the small joints in my hands and wrists were achy and a little swollen, and knees and back were bothering me.

I’m not the only one who’s noticed this.  It’s been shown that low-glycemic diets (i.e. low-sugar diets) are associated with lower levels of inflammatory markers in the blood.  Eating a lot of sugars and simple carbohydrates increases inflammation.

2.  Cravings

The more sugar I eat, the more I want.  This is a known fact, because sugar acts kind of like morphine in the brain.  The less I eat, the less I want, after a few days’ withdrawal period.

3.  Fatigue

I’m tired.  Those of you who know me know I’m almost NEVER tired.  I know that if I avoid sweets and junk food, I feel much better and have much more energy than if I indulge.

OK, so now I’m heading home and will be back in my normal routine after a day or two.  What will I be doing to “detox” after a week-long bout of sweets and junk?  Five things.

1.  Eat healthy

Back to my normal diet of fresh fruits and veggies, whole grains, nuts, seeds and healthy fats:  my smoothee for breakfast, healthy packed lunch and sensible dinner.  Not to mention my normal supplement regimen of Vitalizer Women, Stress Relief Complex and Zinc Complex.  I brought my supplements with me but, as you know, the most awesome supplements in the world aren’t up to the job of counteracting a crappy diet :-/

2.  Drink plenty of water

Water is the antidote to just about everything.  It flushes toxins from the body through urine, stool and sweat.  It supports the work of the kidneys and liver, among all the other organs.  Very few things are as effective as fresh, clean, pure water at making you feel better.

3.  Avoid sugar

I am NOT looking forward to the cravings I will be suffering in the near future.  Like a junkie looking for a fix, except in this case the fix is EVERYWHERE!  Sugar is everywhere you look nowadays.  Luckily in my case the cravings tend to subside in just a few days.  While they last, they are pretty bad though.  I’ll apologize to my office staff in advance on Monday, just in case I’m crabby!

4.  Get plenty of rest

Sleep helps with fatigue and cravings.  Also, sleep is a good way to recharge the batteries and increase your ability to deal with annoyance and minor irritations.

5.  Exercise

I need to get back into my normal exercise routine.  Exercise releases endorphins and makes you feel better.  It also alters the hormones that deal with sugar metabolism, reducing the tendency to have highs and lows and sugar cravings.  There’s also a psychological boost in knowing you are on the right track back to taking good care of yourself.

It’s pretty typical to fall off the wagon of eating right, exercising and sleeping properly, especially when you’re on vacation.  I do it too!  But if you have a plan to get back into the groove, one week of misbehaving doesn’t have to derail all your efforts to be healthy.


Happy Healthy Easter!

Happy Easter everyone!  This is a wonderful opportunity for families to get together and enjoy some time relaxing.

Unfortunately, it’s also a great time to overeat and binge on candy and other junk foods.  If you’ve got a goal to be healthy and and lose or maintain your weight, Easter can be a real challenge.  How do you have a healthy Easter?

I’ve come up with 4 suggestions for a happy but healthy Easter holiday.

1.  Relax

First of all, remember that it’s just one day.  Focus on the fun and time spent with family and friends.  Do your best but remember that tomorrow you’ll be back to your normal routine.

2.  Be active

If you’ve got a family gathering to attend, pregame with a little exercise.  Exercise suppresses appetite and also can counteract any stress that you might feel at dealing with family members.  Let’s face it, not all family members are easy to deal with!

When you’re spending time with family, encourage some physical activity. Take it outside if weather permits, and toss a baseball, football or Frisbee.  Chase the littles around in a game of tag.  Fresh air and exercise is good for everyone!

3.  Load up on veggies

When it’s time to eat, go ahead and sample the deviled eggs but make sure a good part of your dinner plate is covered with green beans or broccoli.  Have a big salad before eating.  Treat the high-calorie foods like side dishes and the healthy low-cal fare the main entree.  Remember, portion control is key, not necessarily avoiding treats altogether.  If you’re not sure whether there will BE a healthy entree bring one yourself, to share.

4.  Remember the reason for the holiday

If you’re ever tempted to feel bad about yourself today because you overate or didn’t exercise or got irritated by your crazy uncle, remember why we’re celebrating today.

John 3:16-17  “For this is how God loved the world: he gave his only Son, so that everyone who believes in him may not perish but may have eternal life.  For God sent his Son into the world not to judge the world, but so that through him the world might be saved.”

The best part is that even if you were the ONLY human on Earth, God would still have sent His Son to suffer and die to save you.  Please spend some time in prayer today.  God loves you just the way you are, and wants you to have a happy, healthy Easter.  Even better, He wants you to have a happy, healthy day EVERY day!

I hope you have a peaceful, joyful Easter with those you love.  God bless you!