The healthcare system in the U.S. has been under scrutiny for decades. Over the years, the quality of care has gone down while the salaries of doctors have gone up. Premiums continue to rise, while coverage is reduced. Most people are on board with reform, but they don’t always agree on what’s best.
In Slate.com’s "A Short History of Healthcare," Timothy Noah describes the difficulty of reforming healthcare in the U.S. He says the problem comes from a combination of inaccessibility to those without it, and a lack of benefits for those who have it. Meanwhile, insurance companies and hospitals are at war over who’s going to pay the bills.
In the end, Noah notes, people in the U.S. pay about twice as much per capita as in Canada, France, and the UK. Unfortunately, the higher cost doesn’t translate to better care. Surprisingly, the U.S. has a lower life expectancy than the other countries. Part of the reason doctors have been receiving higher paychecks, despite poor results, is because until now, they’ve never had incentives based on the quality of care.
Value-Based Healthcare Is Entering the Medicare Scene
The structure of healthcare as we know it is changing; doctors are finally being given financial incentives based on the quality of care provided to Medicare patients. Soon, this model will expand to every patient.
A Privately Funded IT Startup Is Supporting Value-Based Care
These value-based programs don’t run themselves. It’s up to hospitals and providers to stay organized while adhering to these programs. Billing for Medicare is already confusing, but IT startup SA Ignite is simplifying and automating the process with software.
Founded in 2009, SA Ignite provides powerful software to automate the pay-for-performance process. Developed by people who know Medicare billing regulations well, the software is designed to help clients evaluate the quality of their performance and redesign their MIPS programs to maximize incentives.
According to SA ignite, "SA Ignite’s compliance management and predictive analytics platform simplifies the complexities of evolving value-based initiatives, including MIPS and Meaningful Use for Medicaid. Some of the nation’s largest healthcare organizations optimize their quality scores to reduce reputational and financial risk with the help of timely, actionable insights from SA Ignite."
As of 2015, SA Ignite had captured the loyalty of more than 10 EHR brands, and helped over 8,000 providers earn over $80 million in Medicare incentives.
By 2017, SA Ignite experienced a 43 percent increase in usage since the previous year, and the company continues to reach more clients. This technology is a welcome solution to some of the most complex regulations in the industry.
How Did the Healthcare System Become So Complicated?
In his book "Sick: The Untold Story of America’s Health Care Crisis — and the People Who Pay the Price," Jonathan Cohn explains how it started. By the 1920s, doctors had only been reliably treating sick people for less than a decade. At that time, doctors were charging more than people could afford. Because of this dilemma, Blue Cross was created as a nonprofit health insurer serving local community organizations to bring healthcare to those in need.
This original Blue Cross organization was able to offer low-cost premiums because of the tax breaks they received. They charged the same premium amount for every person regardless of age, gender, or preexisting conditions. However, that model was turned upside down in the 1940s when more private insurers entered the market. As they saw the potential for profit, private insurers began calculating risk, raising premiums for some and altogether denying others.
As providers began charging more and covering less, healthcare became a highly profitable industry. Doctors didn’t have any incentive to increase the quality of care because their salaries were not tied to patient outcomes.
With the goal of lowering healthcare costs, improving quality of care, and increasing successful outcomes, value-based care is about to change everything.
Not everyone is convinced it’s a good idea; it’s difficult to shift out of an old paradigm when part of that shift requires taking a pay cut. Value-based care means hospitals are essentially being paid less to deliver higher quality care.
However, this is how it should have been from the start.
Larry Alton is a professional blogger, writer, and researcher. A graduate of Iowa State University, he's now a full-time freelance writer and business consultant. Currently, Larry writes for Entrepreneur.com, Inc.com, and Forbes.com, among others. In addition to journalism, technical writing and in-depth research, he’s also active in his community and spends weekends volunteering with a local non-profit literacy organization and rock climbing. Follow him on Twitter (@LarryAlton3), at LinkedIn.com/in/larryalton, and on his website, LarryAlton.com. To read more of his reports — Click Here Now.
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