Dr. Lou is one of the wisest men I know. He is also possessed of one of the hardest heads and kindest hearts. I know him to be the kind of man who, if he could live to be 150 would spend most every waking moment attending to the needs of his patients, whom these days are mostly children of the medically indigent. It turns out that he has a plan. It begins thusly:
It is almost common knowledge that our health care system is in a state of chaos. Dominated by governmental bureaucracies and the bureaucratic maze created by the various mega health maintenance organizations, insurance companies and a supporting cast of hospitals, pharmaceutical companies and laboratories, costs spiral and our federal deficit swells. Worse yet, those needing and seeking health care are often put off, delayed or denied the needed care. The bean counters in the various bureaucracies decide who gets care and, if they get care, what care consumers (patients) get. Medicare and Medicaid costs, including pharmaceutical costs, are like a runaway train. These costs comprise the lions’ share of the federal deficit. This has been well documented in many writings published in the New York Times and other major papers and by television money reports. Efforts to positively, definitively, and permanently correct the health care problem have failed. To date, changes in the system proposed by politicians and others have been little more than bandaids applied to a wound hemorrhaging money. As a result, the taxpayer is drowning in red ink. China, who floats a huge piece of our deficit, has a choke hold on our economy. The purpose of this proposal is to offer a completely new approach to health care in our country.
I am woefully ignorant on the economics of health care. What I do know is that it could be a lot cheaper than it is and some parties in America are getting away with murder. How do I know this? Because in one of my first serious jobs, I learned that the State of California was well on its way to funding a health plan for the medically indigent of Los Angeles County. If only we had been able to get a block grant for the program, instead of several layers of bureaucratic oversight, it would have worked. I designed the interim capitation accounting system on an Apple II computer. That was 1982.
Today my experience tells me that accountability in the health care profession seems all but impossible. From the perspective of a systems professional, it is my experience that health care systems are the most technically backward, confusing and outdated. If you work in IT, the last place you want to work, well aside from perhaps construction and the restaurant businesses, is in health care. The industry is rife with custom-hacked systems designed by individuals who are part-time doctors and part-time programmers. The systems represent the worst of both worlds, and they are almost always intractably embedded in the culture of the business and integrate with nothing. I've heard that HIPAA initiatives both multiply and uglify that state of affairs, but that's just what I've heard. I mean stick security on top of something that is almost impossible to make sense of in plaintext and you get an idea.
Let me put it to you this way. It was only about 7 years ago that the first system *ever* was put in place that took a systematic accounting of indications, physicians, and prescriptions and tied that to money spent at pharmacies and reimbursed by insurance. It was done by some associates of mine, including George Trudel, one of the good guys.
Some companies are opening their warehouses to customers. MIM Health Plans Inc., an independent pharmacy benefits-management company, lets its customers view data culled from MIM's warehouse so they can make better buying decisions. For instance, benefits managers can view reports and drill down into the warehouse to see claims costs, overall costs, the number of prescriptions ordered in a given time period, the number of brand vs. generic drugs, and other metrics, according to George Trudel, OLAP manager at MIM Health Plans, a Wakefield, R.I., subsidiary of MIM Corp.
Think about it. Imagine that you were a member of a health plan that allowed you to look at other members who used the same drug as you so you could do comparison shopping for pharmacists or vs generic drugs. The technology to do this is old. The need to do this is constant. The incentive and willingness to do this is close to zero. Big carrots and sticks are necessary, and perhaps a little bit of dynamite.
I'm hoping that someday I'll get another opportunity to work in this area. I've done some work for Medtronic and BCBHs in several zipcodes back in the day, but it has been quite a while. These days, there aren't many people thinking creatively about what transparency and efficiency can be achieved with the proper tech. I think that's a consequence of the lazy outsourcing school of 'thought' prevalent in today's large businesses, but let me not go there.
In the meantime, give Dr. Lou your feedback, and remember that there's always a better way.
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