The ugly truth about health care in America is that being sick is big business. Hospitals, pharmaceutical companies and doctors all profit when a person is ill, and this has led to horrific problems like people being given unnecessary surgeries, doctors prescribing harmful and ineffective medications, and the chemotherapy racket. As more and more people wise up to the fact that the system is basically designed to reward illness, the question of how this situation can be improved inevitably arises.
What if doctors got paid to keep patients healthy instead of keeping them sick? Vermont is hoping to find out as it experiments with a new health care model that would offer hospitals and doctors financial incentives when their patients are healthy rather than only when they come in sick. Should the experiment prove to be successful, they’d like to apply it to 70 percent of their residents by the year 2022, and it could cause a sea change in the way Americans pay for their health care.
Instead of paying for each X-ray or operation, lump sum payments will be made to keep people healthy. One aspect of this is focusing on diagnosing the problems that affect a person’s well-being, such as food, housing, and transportation.
This year, OneCare Vermont, an accountable care organization, has transitioned 30,000 Medicaid patients into their experimental model. Their system’s software can identify people who have chronic health conditions and other complex medical needs so that care and support can be coordinated for them. Rather than billing for medical scans and overnight stays, the hospitals are getting upfront monthly payments for managing the care of the patients they are assigned, while primary care practices will get payments for helping with outreach.
BlueCross has said that it is hoping to move some of its members into this new payment model next year, including those who buy plans using its Affordable Care Act exchange.