What if health insurance companies were liable for the outcomes of your care?

I read an interesting article on KevinMD, a blog that is written by physicians discussing different issues that pertain to the practice of medicine.

Many of the articles are designed to help doctors with different problems such as burnout, financial planning or even working in systems that can be abusive to the doctors, nurses and other people working in those systems.

A few years ago, insurance companies finally lost their exemption to being liable for anti-trust. For many of us who have endured both financial and systemic hardships at the hands of insurers who have abused the system with audits and precerts, this was welcome by the providers of healthcare. Most of the consolidation we now have was because the system has been monopolized however, the quality of care has worsened and become more costly as doctors have been economically forced into working for the systems.

Insurance companies do not incentivize great outcomes. They do incentivize procedures and many of these procedures are designed to get in the way of healthcare, as insurers are middlemen profiting as the cost of care skyrockets.

One of the blogs asked

While the medical view of this may be different due to their experiences, would this change the current regime of minimal evaluations, tons of costly tests, and the patient being passed around from specialist to specialist? Often, the large systems have no interest in proper diagnosis efficiently since they profit from every encounter. They also as a rule incentivize doctors to refer in their systems, even if the best care may be outside of that system.

This results in more tests, evaluations, costly hospital-based scans, and more. Emergency rooms are more like waiting rooms with far higher costs than urgent care which is one size fits all medicine often to again feed the system that owns the urgent care. This is why you may see two to three urgent care offices within a block owned by large healthcare systems that are monopolizing care in the area.

Right now, insurance companies constantly delay, deny, and get in the way of medically appropriate care. Some of us have died due to these activities while waiting for approval. On the other hand, getting these treatments which may offer life extension but not cures should also be questioned. What is the quality of care anyway?

As a chiropractor, quality of care is doing the best for the patient and having a good outcome so they can avoid needing further care for the same problem. I often see patients who have been to other chiropractors or therapists and even orthopedic doctors who simply did nothing short of make a poor diagnosis and pass them along the chain of providers while their problems became more chronic. Would you have fewer imaging studies if doctors were reimbursed for better care and better outcomes?

Medically, the idea of managing instead of curing may be challenged. Can you help the diabetic improve their A1C and return to pre-diabetic status? Perhaps, the patient is rewarded with better health and fitness and the doctor should get a bonus for helping them eliminate future complications.

Some of the ideas that CMS has tried to improve quality and costs merely took medical clinics and incentivized them to improve their processes and then the savings would be shared with the clinic or systems doing this. These value-based programs so far have shown only modest savings. Perhaps, the model is the problem, and any ACO or other acronym is merely another attempt to keep these bloated systems together when the real problem begins with simplifying it all through primary care. The AAMC has their accounting of how these programs have worked and perhaps, we should go back to simpler systems of everyone in primary care with a specialty looking at people and relearning how to not one size fits all their patients.

We should speak to those of us on the front lines such as primary care and even chiropractors. Many of the answers can be found by those servicing the public on the front lines.

One of the best approaches is to simplify care and coverage. We should begin by expanding Medicare as the private market has failed miserably in addressing costs and will delay care which is dangerous for our health.

Maybe expanding Medicare to everyone can be cost-effective for all of us. Then build in incentives to reward doctors and systems for outcomes rather than tests, procedures, games, and protocols. Even more important would be the cost savings by making health systems more efficient with staffing for effectiveness vs. procedures to get paid and staff that spends all day on protocols, notes, and things that have little to do with the most important element of healthcare; outcomes.

Chiropractic has always had efficient models to reduce pain and improve health. The current Medicare model unfortunately only covers manipulation and seniors who are enrolled need to pay for their own evaluations as well as the other services that modern chiropractic offices provide. You can help get these bills passed by using this link and writing to your legislators. Reduce costs and improve effectiveness through chiropractic in Medicare by following this link;