Seeing the Elephant
Now here is a new concept – – CHANGE!
We really haven’t seen much in healthcare over the past 5 to 7 years.
I ends up that some of my readings for a course I am taking, published in 2009, are about some issues in healthcare administration that as of yet have not reached their peak.
The main issue here is the transition from Quality of Care analysis to Population Health analysis. I favor the latter, worked in the former ten years ago. 2009 was the turning point for when changes were supposed to be made in order to drive the transition into population health care and analysis along the right routes.
Sorry to those who had such wishes that this change might happen. It is far from even being on its most important uphill rise to success.
The Insurance companies and other businesses responsible for implementing these changes are–for lack of better words–too old fashioned and resistant to change.
True, the idea of changing things this quickly, this much, seem quite hard to fathom. But the companies that should be embracing these changes, those that are to be closely associated with the Obamacare related changes, are too stubborn to take on these new responsibilities.
The idea of change has never been an active way of thinking in health insurance companies.
Sure, you want to think that new prevention program is a good example. But I hate to say it is as great and effective as those anti-smoking hot line programs. When I was monitoring the health of 60,000 for several years, of which a few percent were smokers, none of those several hundred to a thousand every used that hotline provided for by the program they were enrolled in. 15 total in fact could be documented as calling for help, or assistance on how to stop smoking. With this in mind, how many members do you really think are going to participate fully in the regular health monitoring prevention programs develop? that place of the web where you can enter your goals and activities, or calculate you success with BMI changes and weight loss?
One such website that I enrolled in I never went back to again–it provided me with nothing new, other than to keep my workout logs on a computer instead of in my pocket sized notebook.
That was way to much time and work, and fat-developing desk time to manage, for a program designed to help someone lose weight. Likewise, I don’t need their pictures of a healthy meal to know what a great salad looks like; I already know what to put into my salad. There is no incentive to use these kinds of sites. Those few incentives that in fact exist, are really more theoretical. At one work place, I saw those who did participate in such company-based offering were already engaged, fully, and wanted to succeed even more by getting a 5 dollar Starbucks card or better yet, a 50 dollar accessory for whatever events they regularly engage in, such as running or swimming.
So the healthcare system and plans for change are as much unchanged today, as they were in 2009, or 2004/5. I had the opportunity to see what plans were then in process with national healthcare, and can’t believe the Obamacare plan had some of its decisions already made in 2009, published as parts of the ongoing improvement programs I regularly engaged in and directed most of the research for in 2004/5.
That just demonstrates to me, and maybe others, how resistant to change we and the leaders in healthcare finances are.
These companies that fund our care are not leaders in their field. They are providers of the most basic needs only. They could easily implement a very effective population health care monitoring program to oversee their expenditures with. But instead, they’d rather take the passive role and whenever active, complain, refuse or resist for the most part.
One such company even tried to hire me to monitor those patients who might opt out of care with their competitors, in exchange for seeking a new form of care through their agency. Had I been hired, my goal was to detect or predict these high cost people frustrated with the program they are in, in need of better care elsewhere. It was not the better care that this company thinking about hiring me was so much against. It was the cost for providing them care.
This tells us that insurance companies want to recruit only the healthiest, least costly of members. Not anyone who is handicapped or in desperate need of improved care. Just the minimum number needed to meet their quotas, provide some services, and very easily demonstrate just how effective they are for keeping people healthy, not making sick people better.
What I state above is therefore true–the truth sometimes hurts about healthcare insurance industries.
My recommendation: don’t ask for a pain reliever; it may not be on the flowchart somebody developed to improve your therapy, or pre-approved by your insurer, for recommendation by your PCP.
My readings that led me to write this essay: