Value Based Care - Healthcare Reform without Single Payer or the ACA

[sheltiedave]

No, Whell, my premise is correct. Insurers do not provide health care, hospitals, doctors, and nurses do.

One of the best things we could possibly do is get the insurance companies out of the picture, but until we do, they are a necessary evil.

[whell]

Originally Posted by donquixote99

This pilot program was created with a grant, in response to ACA mandates. Big government, no?

Not really. Health costs were increasing prior to the ACA. However, Nemours - organization you site - is not an insurer. Its an integrated health care organization. Thanks to provisions that require payers to cover patients with preexisting conditions and adhere to premium caps that have reduced their profitability, the ACA has incentivized a quick shift towards value-based care. Eager to trim costs, pay for fewer services, and attract as many patients as possible in a competitive and confusing marketplace, payers have incentivized providers to abandon the traditional fee-for-service reimbursement structure and look to population health management strategies as a way to stem the financial bleeding.

This isn't necessarily a bad thing, but the transitioned was hastened by financial disincentives these organizations were facing due to coverage requirements in the ACA. Yes, there are "innovation grants" avaioable under the ACA and Nemours took advantage of one of those grants that partially funded their pursuit of VBC. But no doubt that Nemours would have had to change regardless.

[whell]

Originally Posted by sheltiedave

No, Whell, my premise is correct. Insurers do not provide health care, hospitals, doctors, and nurses do.

One of the best things we could possibly do is get the insurance companies out of the picture, but until we do, they are a necessary evil.

Docs, nurses, etc. don't do it for free, and the current payment system is not sustainable. We don't need to have big gov't solutions that enshrine in law everything that's wrong with current payment and incentive systems in medicine.

If we got insurance companies "out of the picture" and went with a Medicare for all system, there would be ZERO incentive for changing payment systems and incentives in the medical system. Medicare is a great big fee for service bill payment system funded by taxes.

[Rajoo]

Originally Posted by whell

Docs, nurses, etc. don't do it for free, and the current payment system is not sustainable. We don't need to have big gov't solutions that enshrine in law everything that's wrong with current payment and incentive systems in medicine.

If we got insurance companies "out of the picture" and went with a Medicare for all system, there would be ZERO incentive for changing payment systems and incentives in the medical system. Medicare is a great big fee for service bill payment system funded by taxes.

Sounds like a political statement and rather confusing.
So if we get the middle man aka insurance companies out, what will happen?
Also what incentives do the insurance companies provide to reduce medical cost other than reduced coverage?

[icenine]

Single payer would be a boon to the economy. Employment in the health care industry would skyrocket since more patients would be able to get care at more facilities. Just imagine if we built the mental health facilities that the USA actually needs right now.

Oh course we are further than ever away from that right now, thanks to people who voted for Trump.

[Oerets]

What value would Grandpa have? At what age would a knee hip heart cancer ect... be valued to costly? Or at what age you loose your bed in a nursing home because of cost V age?

Death panels?



Barney

[barbara]

Actually, we have death panels right now. But we call them insurance companies.

Every time I need any kind of treatment or prescription aside from what they considered "primary care" I have to have special authorization from the insurance company.

There have been times when the insurance has refused prescriptions, surgery, and diagnostic procedures. When that happens, doctor has to take the time to justify why he wants me to have that treatment. Sometimes the appeal works, sometimes not.

Isn't the doctor more qualified to know what treatment I need?

And, I have good insurance. Can't imagine what those who have mediocre insurance must go through.

[Oerets]

Barbara, the party so vocal in the past about Keeping your Doctor, getting the proper care when needed. Now is attempting to do exactly what they were accusing the Democrats of.

Psychological Projection by the Republicans?



Barney

[barbara]

Originally Posted by Oerets

Barbara, the party so vocal in the past about Keeping your Doctor, getting the proper care when needed. Now is attempting to do exactly what they were accusing the Democrats of.

Psychological Projection by the Republicans?


Barney

I agree.

[sheltiedave]

But now it is value added outcome based care that will be properly managed to eliminate any rising costs...change the words, but the underlying reasons are constant.

And we all know what they are. It was the very reason the Republicans lined up for close to a year to write ACA alongside the Democrats. Make sure the insurance companies profit. The only problem is Medicare patients result in a loss to insurance companies. Now that the insurers have the figures, they have given the Republicans they have purchased their marching orders...ACA must go at any cost.