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3 Shifts in Medicine (and How It's Paid For) You Need to Watch

Posted by Lawrence Kerr on Tue, Jul 07, 2015 @ 07:00 AM


Healthcare in the US is almost unfathomably complex. Plus, it's always changing, such that it can be very hard to notice trends in any useful way.

However, we are at an especially volatile and important moment in medicine, with the reverberations of the Affordable Care Act still playing out. Just in the past few weeks, I've noticed a few trends that I think every ACO, every hospital, and every medical provider should have their eyes on.

3 shifts in medicine that will probably impact you in the next year:
  • Insurers will be demanding "more" from providers and hospitals.
    On one hand, insurers are squeezed by higher-than-expected costs of the newly insured. Many are now requesting rate increase approval from the government. As the New York Times reports, "The rate requests, from some of the more popular health plans, suggest that insurance markets are still adjusting to shock waves set off by the Affordable Care Act." On the other hand, many insurers are merging, which gives them more leverage over hospitals and providers.  The pressure to increase revenue and cut costs, combine with increased power from mergers may well add up to more demands on providers and hospitals.
  • Non-traditional care contexts are becoming the norm.
    Because of shifts in what is able to be reimbursed under the Affordable Care Act, there are new delivery mechanisms being pioneered. For instance, there is a current boom in diet clinics, due to ACA reimbursement for obesity consultations and treatment. It's likely that as care outside of doctors' offices increases (with other medical providers being the ones actually interfacing with the patient), healthcare collaboration (especially using telemedicine tools) will become more important. Collaboration will need to happen more, and across the spectrum of care, in order for patients not to fall between the cracks.
  • Home care is a growing segment of medicine, and we're (mostly) not doing it well.
    Data is beginning to suggest that there are more homebound people than ever before, and they're sicker. Plus, there are more caregivers who are older family members and need support themselves. This type of dynamic means that medical providers are responding, and finding ways to provide care at home. For instance, there is a growing group of geriatrics practices that make housecalls. And if those housecalls have to be made by specialists because there is insufficient technology to allow collaboration at a distance, that's going to be unsustainable. If these trends continue, we'll need to find ways for the people providing the home care to be supported by other medical providers, in efficient and effective ways.

For decades, medical providers had the luxury of ignoring macro trends. These days, however, I think that we ignore these dynamics at the peril of ourselves, our practices, and our patients. For us to act with wisdom, sustainabily, and in service of good medicine, we must act with these things in mind.

And really, that is more of a privilege than a burden.


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Tags: accountable care, homecare, ACO, affordable care act, home care, affordable care act compliance, insurance,

Does This Approach to Health Insurance Go Too Far?

Posted by Lawrence Kerr on Fri, Jan 09, 2015 @ 07:30 AM


We love bringing you news of innovators in healthcare, like this PA clinic or that project to encourage collaboration. Another story about an innovative initiative raised some questions for us, however.

The New York Times covered the trend of religiously oriented groups organizing health "networks" in which members contribute payments to cover each other's health expenses. As health insurance has become federally mandated, these groups are complying with federal law, but in a way that feels personal, affordable, and enables them to circumnavigate pieces of the law that don't align with their values. 

We get excited when we hear about projects like this. We firmly believe that when regular people get more involved in their healthcare, we all win. Plus, we leap for joy whenever a small group of people find a way for common sense to win out over healthcare madness. It's pretty fantastic that when Erica Beiler gave birth, her expenses were covered and members even sent extra money to help welcome the baby into the world. 

That said, we could never -- as people or as providers -- support the network since things like medical care to gay folks and treatment for STDs aren't covered. It's certainly not a system that aligns with our ethics. Plus, the networks are unregulated, often have a lifetime maximum payout, and there may not be enough money on hand in a given month to cover all eventualities.

Be that as it may, we still are happy to shine a spotlight on a small group of people doing something, taking action, to make the medical system work for them. You may not be a patient or provider that would take part in a network with these parameters, but it does raise the question: how are we taking action, today, to make the medical system work better? How might we take matters into our own hands?


We believe medical collaboration is one easy, fun way to change the healthcare system. Give it a try for free: 


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Image courtesy of holtsman on Flickr, used under Creative Commons rights.

Tags: telemedicine, collaboration, regulatory issues, insurance,

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