Friday, April 18, 2014

My thoughts on: Ezekiel Emanuel's New Book : Reinventing American Health Care +

I.  Ezekiel Emanuel: Reinventing American Health Care

Emanuel has published this new book.   He was a key advisor in the White House on the ACA legislation.  I had the pleasure of hearing him provide a summary of his book earlier this week.  Here are six megatrends that he forecasts for the future.

1) Insurance companies will make greater use of management, analytics, and actuarial services and/or integrated delivery systems
2) Doctors and hospitals will focus on keeping chronically ill out of ERs and hospitals and provide more effective mental health care
3) Many hospitals will close and digital systems will become more widespread
4) Employer participation in health insurance will be dramatically reduced.
5) Health care inflation will be significantly reduced
6) Medical education will be dramatically transformed.

I feel there is a much wisdom and potential reality in these points. Here are some of my thoughts that I shared with him afterwards in which he seems to have concurred:

What do you think of Pay for Performance strategies which are now part of the Medicare program? I think they have potential but have not seen clear evidence so far to support.

I think the Hotspotters as discussed by Atul Gawande has great merit and ties in with your thoughts on chronic care. 

I think it would be very useful to incentivize consumers to select insurance plans based on quality of care measures.  General Motors tried such an approach successfully a number of years ago.

There is a great need to integrate post-acute systems and also to integrate long term care systems.  In addition, to integrate care for dual eligibles.The administration is working on the latter but has not shown a great deal of creativity.   

I think the administration needs to do more to sell Medicaid enrollment, particularly those populations that would benefit the most from such.

I also think the administration needs to do a better job of selling the accomplishments so far and counter the Republicans more effectively. 
II. The Alliance for Health Reform held a very useful session yesterday on Prevention.  There are many positive features in ACA regards prevention but there is much more that can be done from a system viewpoint as well as re funding.

III.  Other articles

Here are other items of interest

Maryland to shift $21m to help stabilize insurance premiums

CBPP Releases New Resource on State Marketplace Design and Policies

Are Exchanges More Appealing To Insurers Now?

1 comment:


    What a timely article!

    What's happening in the health care industry is really scary, even for those who have insurance. I think (opinion) these doctor "teams" (which often include nurses) are the worst thing that ever happening in health care, as far as patients are concerned. The patient is talking to multiple persons who report what you say to multiple persons). If a man (Perhaps women also) has a hernia, he'd better be almost dead before anyone will take any corrective action. Why? Lack of compassion and Insensitivity by medical providers? Prevalence of the problem (It happens so often that nobody wants to pay. How much does a hernia operation cost)? Medical Ignorance (Can it really be repaired with lasting results)? Seems like such a simple medical problem (opinion) and yet, no answers and apparently no real solution. If this kind of confusion is created by a hernia condition, I dread to think what issues other medical condition can create Double the problem in a military VA facility (Interns are doing all the upfront work so veterans never can rely on the information he/she receives). What is the answer to at least improving the compassion in the health care system? God help us all!