How to Make Healthcare Systems More Sustainable

Time for Common Sense: It's Health Systems, Not Health Silos I have addressed this issue previously, and I am sure I will again! This time, my interest was piqued by reports of African public sector hospitals ceasing services due to drug shortages or a lack of personnel. Simultaneously, there is rightly growing discussion about preparing for the next pandemic (let's not forget that Non-Communicable Diseases [NCDs] are already a pandemic!). Health system planning should no more be the focus of siloed stakeholder influenced programmatic thinking, as it can ultimately results in inefficiency, duplication, and increased costs. Collectively, we need to support health systems by placing the patient at the center and examining the constituent parts together, acknowledging their direct and indirect impact. Here are some examples: Payment Structure: Out-of-pocket payments restrict access. More financial coverage is required. Governments must determine what they can afford. Greater value from each dollar spent is essential. Access Points: Primary care, due to its proximity to the patient, is the ideal solution and can drive prevention and early detection. However, primary care should not be isolated within programs. We should focus on building comprehensive primary care, integrating digitization and embracing diagnostics. Referrals: Primary care alone is not sufficient for those with pre-existing conditions. We must decide where hospital services should be located and how patients can access them, while also addressing payment issues. Staffing: Building healthcare services requires a competent workforce. Staffing planning and training must align with delivery needs. Access to Medicines and Supplies: Ensuring providers have proper access to drugs and consumables is essential. Better demand planning and improved supply chain distribution channels should complement service organization. Local Production: To improve access to affordable medicines and consumables, we need better forecasting and access to data to inform production based on demand. This will help inform what can be made in country. Data Utilization: Historically, there has been a focus on individual programs, resulting in a data mess. We need integrated data analysis to drive synergies and efficiencies. Embracing Digital: Implementing digital health and disruptive technology correctly can catalyze change. System-wide strategy should guide its use to maximize benefits with limited funding. Equipment and Servicing: While more medical equipment is required, successful implementation depends on training and in-country servicing at a reasonable cost. Regulation Alignment: Health policy needs to be updated to support strategy and all the aspects mentioned above. As we transition into an era of pandemic preparedness and required change, let's not continue with siloed programmatic influenced thinking. Let's embrace integrated health system planning. The timing couldn't be more opportune.

In my latest Forbes column, I propose five practical reforms that could enhance the Medicare Advantage program, making it more transparent, equitable, and effective for the seniors and communities it serves: 1) Pilot Mult-Year Enrollment in Plans. No matter what anyone says about their value-based care results, value is ill-produced in healthcare in one year increments. 2) Standardize Plan Benefits. Plans are competing on nonsense and unsustainable benefits—often leading to a bait and switch for seniors. Standardizing benefits will improve plan competition and ensure every plan delivers consistent and meaningful value. 3) Reform broker incentives, rewarding year-round member support—not just sign-ups. Effectively deployed, brokers can be the missing glue we need t improve American healthcare. 4) Vary maximum broker commissions with star ratings. Star ratings should be an accelerant to sales. Fact: Today, a good number of brokers will tell you they don’t even know plan star ratings when they sell them. 5) Drive adoption of capitated payments to align provider incentives toward coordinated, value-based care. Health systems have been snookered by health plans who non-transparently push off the costs of supplemental benefits and other expenses. This explains why so many health systems complain of underpayments while MEDPAC claims Medicare Advantage overpayments. There is a better way. Collectively, these reforms aim to improve the quality of the Medicare Advantage marketplace. As we collectively work toward building a more sustainable healthcare system, these are actionable steps that lawmakers, payers, providers, and advocates can take now. I invite you to read the full article and share your thoughts: how might these recommendations reshape Medicare Advantage—and what additional levers are we missing? https://lnkd.in/gQmevX5K

In my years in healthcare, I've observed a troubling disconnect: while home health services consistently provide quality care at lower costs, they remain severely underutilized in our healthcare system. The evidence is clear - patients heal better in the comfort of their own homes, experience fewer complications, and report higher satisfaction with their care. Home-based services prevent costly hospital readmissions and reduce the need for facility-based care. Yet our current reimbursement structures actively discourage utilization. Fee-for-service models, where reimbursement is often below the cost of providing care, offers inadequate compensation for home-based solutions. Yet healthcare providers have little financial incentive to experiment with new care models absent a payment mechanism. This misalignment between patient outcomes and financial incentives creates a system where the most cost-effective options may be the least financially viable for providers. If we're serious about bending the healthcare cost curve while improving patient experience, we must test new reimbursement models that incentivize scalable and cost-effective home-based services, including key elements such as: ◾ An efficient and focused home-based assessment that identifies key real-world challenges in the patient's living environment ◾ Care coordination services to navigate follow-up appointments and medication regimens ◾ Dedicated caregiver support, including personal care assistance and respite options ◾ Care gap identification with connections to community health resources and solutions Value-based payment systems that reward providers for delivering efficient, effective care in the home are long overdue. #HealthcareReform #HomeHealth #ValueBasedCare #HealthcarePolicy

Centers for Medicare & Medicaid Services recently unveiled a transformative model to test a state’s ability to improve the overall healthcare management of its population. The States Advancing All-Payer Health Equity Approaches and Development Model (“States Advancing AHEAD” or “AHEAD Model”) aims to better address chronic disease, behavioral health, and other medical conditions. Under this voluntary model, participating states will be better equipped to promote health equity, increase access to primary care services, set healthcare expenditures on a more sustainable trajectory, and lower healthcare costs for patients. It's the next iteration of the CMS Innovation Center’s multi-payer total cost of care models for Medicare, Medicaid, and dual-eligibles. States participating in AHEAD will be accountable for quality and population health outcomes while reducing all-payer avoidable healthcare spending to spur statewide and regional healthcare transformation. The AHEAD model will: ✔Focus resources and investment on primary care services, giving primary care practices the ability to improve care management and better address chronic disease, behavioral health, and other conditions. ✔Provide hospitals with a prospective payment stream via hospital global budgets, while including incentives to improve beneficiaries’ population health and equity outcomes. ✔Address healthcare disparities through stronger coordination across healthcare providers, payers, and community organizations in participating states or regions. ✔Address the needs of individuals with Medicare and/or Medicaid by increased screening and referrals to community resources like housing and transportation. States are uniquely positioned because they have existing relationships with hospitals, primary care providers, payers, local government and communities, and non-profit organizations, which can be leveraged to improve population health and advance health equity. This model breaks down a very important silo and I'm rooting for this to work! #healthcareonlinkedin #healthcare #populationhealth #chroniccaremanagement #sdoh #chronicdiseasemanagement