The current presidential campaign, in major part due to the entrance of Paul Ryan into the campaign, has propelled the cost of healthcare (versus a general discussion of the ACA) into the limelight. While this is not a bad thing, little has been said about the process of providing healthcare itself versus the legislative budgetary process. Certainly changes in how Medicare is paid for and Federal versus states oversight of Medicaid funds are important. However, as the economics are great fodder for political debate, what is lost is the power that lies in changing some of the paradigms in healthcare delivery. I would submit that both political parties would likely agree with the following points.
1. Something needs to be done. The days of one candidate saying that the healthcare crisis is exaggerated by the opposing party are clearly over. That Medicare cannot continue in the current manner is not debatable. Whether changes which would extend viability of the program 8 or 10 years, is better than a total revamp of the system is a debate which is unfolding and destined to define the candidates. Among revolutionary fixes to healthcare (both on an economic and delivery process scale) is the use of digital health technologies. The reimbursement for wireless technology recently (WellDoc’s DiabetesManager) is a sign that big steps are about to happen.
2. Increased Patient and physician engagement will revolutionize care. What will be overshadowed in the healthcare economic debate are huge contributions which lie in efforts to change the way both providers and patients see their own roles. There is much press about patients taking more responsibility for their own care. Medication and treatment regimen adherence is known to be a major contributor of healthcare expenses. What isn’t as publicized as much (or enough) is physician engagement. Most physicians are overwhelmed with regulatory requirements and institutional requirements (as most are or will become employee physicians), and are frustrated with lack of time to do what they entered the field of medicine to do, which is to be with patients. Physicians have been essentially reduced to quality control officers, leaving most patient interactions with nurses and other healthcare providers. Digital health technologies can paradoxically increase interactions between physicians and patients in more meaningful ways than the 20 minute office visit. Political candidates need to realize the importance and support such technology efforts which will increase engagement.
3. Cheaper and more efficient technologies should be supported. The days of hospitals bragging that they have the newest, biggest surgical robot or MRI machine or implantable defibrillators released every quarter with new clinically meaningless ‘bells and whistles’ are over. Neither technological stagnation nor bootstrapping is what I’m recommending. Digital technologies which will replace nursing call buttons on hospital beds, switchboards jammed with calls from relatives and caregivers, and visiting nurse vital sign visits. The importance of healthcare in this regard should be no different from emphasis placed on energy technology development.
4. Aging at home needs to become a priority. Half of all deaths from infection are a result of hospital –acquired infections, according to a study looking at 69 million hospital discharges between 1998 and 2006, published in February in the Archives of Internal Medicine. In addition, over 30,000 deaths annually are due to medical errors. These statistics, compounded by the aging of America, make the idea of keeping people at home except for major illnesses more attractive. Digital technologies will facilitate the aging at home concept, keeping patients who are sick at home, yet monitored and cared for via technology-related interactions including telehealth. In addition, these services, because of their cost savings, will likely be reimbursed, and thereby decreasing costs of long-term care insurance.
5. Informatics needs to be incorporated into medicine. Big Data has become critical to business, government, and finance. It has yet to become a paramount cog in the healthcare industry engine. The foundation for medical informatics is first being built. Informatics will be the basis for tracking patient outcomes, reimbursement for bundled payments, physician and institutional ratings, and ultimately patient treatment plans. Preaching the development of robust data harnessing in healthcare would energize all stakeholders involved.
The problem of having candidates agree on issues is that it is seen as bad politics. However, the electorate would learn about non-economic issues in healthcare, including how digital technologies can improve care, become more involved, and be proud to contribute themselves. What’s so bad about consensus?