The face of healthcare is changing rapidly. We are seeing more innovative strategies and solutions for improving healthcare. The conversation over the role that politics has played and should play in care is a trending topic, and addressing mental health care is losing some of its stigma. This forward momentum is setting the stage for positive health outcomes for both providers and members.
Let’s take a closer look at some of the stories that we’ve been paying attention to.
There are more than half a million homeless people in the U.S., about a third of them unsheltered. When they need medical care, or sometimes, just a bed and a meal, many go to the emergency room. This is where America has drawn the line: we’ll pay for a hospital bed, but not for a home. Even when a home is cheaper.
Enter Jeffrey Brenner, a doctor who has worked with homeless individuals for over 25 years. After decades in nonprofits, he’s now an executive at UnitedHealth Group Inc., America’s largest health insurer. His agenda: give people places to live. His plan is to offer housing to members who are homeless and whose medical spending exceeds $50,000 annually, with the majority of that coming from ER visits and inpatient stays.
Housing may not solve all of the problems each individual has, but it has made a profound difference. ER visits are no longer a routine part of this group’s care, which is welcome news to UnitedHealth. And more importantly, it’s bringing humanity back into their lives.
The emerging value-based care model of healthcare delivery is unique. It must be created through innovation and a shared commitment by the many stakeholders in the complex network of healthcare.
Intermountain Healthcare, a not-for-profit healthcare system based in Salt Lake City, is pivoting to value-based care and seeing excellent results. The transformational model is founded on five core principles:
The enemy is the disease, and we must speed up the connection between science and member care. The ways to improve public health should be based upon and responsive to the best science we have to offer. The goal should not be political victories, but rather, improving public health.
We must be willing to disrupt the traditional for-profit model of pharmaceutical production. Intermountain Healthcare has joined with numerous healthcare organizations to found Civic RX, a not-for-profit company whose mission is to ensure that essential generic medications are accessible and affordable.
We must link healthcare providers and health insurance providers so that they jointly benefit from improving the health of a population. Providers and payers work together in increasingly close collaborations, so that they share the risks associated with poor health and the benefits associated with good health.
Reducing the cost of healthcare, while at the same time, improving care. When providers share risks and benefits with insurers, hospitals benefit from better, rather than more, care.
We must work with the public to confront the social determinants of health. We must engage the public in changing lifestyle behaviors and living environments, and assist them in achieving that goal.
There’s been a cultural push to elevate mental health to the same level of importance as physical health. However, insurance coverage still hasn’t caught up with this evolving mindset.
According to recent studies, Americans who are feeling the most pain by insurance providers are those who seek out treatment for substance use disorders. Researchers at Ohio State University found that mental health members who sought behavioral treatments spent more money out of pocket, and received more out-of-network care than those seeking treatment for chronic physical conditions. Lead author Wendy Yi Xu finds: “Much of this disparity is likely due to the limited availability of behavioral health care providers in insurance plans — the participation rates by these providers are generally low …”
One in every 16 Americans (around 20.3 million people) has a substance abuse disorder, and a little less than half of them have a co-occuring mental health disorder. Yet the stigma surrounding these disorders persists. The question we should be asking is: how and why are people suffering, and how can we solve it?