Transformation of Healthcare - Moving Towards Value, Not Volume

by Patrick Riley 23 Sep 2013
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What began in 2009 as a movement towards universal coverage and legislation to mandate all eligible Americans to have health insurance, now is caught in the "death roll" of U.S. politics. Around the globe costs for the delivery of health care continue to rise, out-pacing  country GDPs and physician quality variance expands or ebbs on a scale that is ill defined. Yet, governments and healthcare leaders have tried, again and again to contain costs and centralize quality in centers of excellence. Capitation was seen, by many, as the utlimate cost containment, only to discover that what it does is force providers to restrict treatment, thus, lowering costs at the expense of imiproving quality outcomes.

The inclusion of the establishment of health insurance marketplaces in the Affordable Care Act is intened to provide literally millions with health insurance, and with coverage, access to a care continuum. Yet, the first scrub of premiums reveals that they are much lower than anticipated. Why? Insurance companies participating in state insuranc marketplaces, or exchanges, have strategically shrunken geographic coverage and number of proivders in their networks, to keep costs down. So, quite possibly, by gaining an insurance card, may not guarantee access to the providers required to address chronic disease and costs will not come down.

The healthcare value equation is not valid. In other words, costs are being controlled and as a result, quality outcomes will be jeopardized because patients will not find the level and quality of care needed in their networks and costs will increase. This has been a common anomaly of past strategy by insurers and policy pundits alike. We need to make sure health insurance marketplace networks are robust and accessible to insured populations to balance the healthcare value equation.

You can follow me on Twitter @Patrick_FrostHC and continue to read my daily blog on connected health on

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