Health care has come a long way over the past 10 years. Legacy systems have been replaced with tech-forward EHR solutions, big data analytics, and interoperability. Today, a majority of health providers share patient data and notify primary care clinicians of complications.
These transitions however, have taken a toll on medical providers - both on the workforce and financially. Plus, many issues that contribute to the rise of chronic illness, such as social factors and comorbidities, remain unaddressed.
In the wake of the ACA, value-based care and MACRA, hospitals are reeling from uncertain funding and unreliable patient streams.
What U.S. hospitals are up against
In reality, the problems didn’t start with the implementation of new health care policies and regulations. These issues go way back.
Segregating patient care
For instance, the US has a unique way of separating comorbid conditions. Behavioral health has been carved out of the rest of health care and treated independently from other physical conditions. Yet approximately 40 percent of all medical costs are influenced by mental health issues.
While many clinicians are tasked with treating physical conditions, patients aren’t getting the whole picture of their health. Patients don’t know how to make the right changes to alter both their emotional and physical conditions.
In the end, contributing factors such as depression are often overlooked in favor of treating physical ailments.
The struggle to survive in a shifting landscape
A recent study revealed that around 75% of the hospitals in New York state are shrinking. This is while statewide hospital revenue is increasing. This discrepancy, influenced by the rise of urgent care clinics, preventative medicine and telehealth is a result of decreased inpatient admissions. This leads to lower hospital earnings.
Plus, many of these medical establishments have a large inpatient and outpatient volume that’s covered by Medicaid. But the reality is that often these reimbursements don’t cover the total cost of delivery.
What we’re seeing is that large hospitals such as university health systems are thriving while smaller hospitals are becoming obsolete. In other words, stand alone hospitals are struggling to survive. The result is that many geographical regions may soon have limited access to care, only aggravating the issues within population health.
What New Zealand has done to prevent a similar crisis
Melon Health has the privilege of working with health systems around the globe, particularly in New Zealand. NZ has been strategically coordinating care for comorbid conditions such as mental illness and chronic disease.
This approach has led to whole-person care models that treat conditions holistically in order to get the best patient results. For instance, depression often contributes to sedentary lifestyles and comfort food choices. Clinicians can preempt conditions such as obesity or heart disease by addressing a patient’s depression.
In addition, New Zealand focuses on integrating with primary care. In this way, patients’ conditions can be consistently monitored to improve their chances of whole-person wellness. Patients are challenged to engage with their health and make behavior changes that improve their quality of life.
What New Zealand has demonstrated is that chronic disease and comorbidities don’t have to result in declining health systems. With the right emphasis on integrated health, interoperability, patient engagement and primary care, clinicians can monitor more patients. This results in better outcomes and improved revenue streams.
As a result, New Zealand typically spends less per capita on health care than most countries. The United States might also be able to benefit from this model of wellness.
Looking toward the future of health systems
We need more than just government policies or better funding to reconstruct floundering hospitals. Thankfully, in the case of New York’s hospitals, providers are putting forth a new model of care. This model focuses on primary care similar to that of New Zealand.
This new business model emphasizes ambulatory care scattered across geographical areas to offer supported self-managed and treatment options for patients. Rather than focusing on individual hospitals, stakeholders are joining together to create a cohesive partnerships. These partnerships can withstand the mounting financial pressures in the health care industry.
This new model of collaboration also relies on a shared services infrastructure and a unified governance structure. This will allow providers to better engage patients and improve scalable health care.
In conclusion, health care across the U.S. needs more than just individual efforts to make real change. It’s going to take partnerships, unified infrastructures, and an emphasis on primary care models that emphasize whole person care. This is the formula that will improve long term outcomes within health care.
The good news is that models, like New Zealand’s, have shown the effectiveness of innovative models of primary care in preventing and managing chronic disease. As the U.S. adapts its systems to mirror the models that are averting health care crises, we can experience similar outcomes.
What do you think is the path forward for U.S. primary care?