Setting the Stage for the Next 10 Years of Health Care Payment Innovation

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    • #443161
      eridani
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      • Total Posts: 9,978

      https://jamanetwork.com/journals/jama/fullarticle/2783356

      Ensure That Payment Systems Reward Multiyear Investments in Health
      A major shortcoming of the current system is that investments in health have very short payback periods. These time frames make it challenging to invest in interventions that have longer-term benefits, even when these investments may produce substantial improvements in health.

      A new funding mechanism for breakthrough preventive care, such as health-related bonds, which are held by investors, and which increase in value along with a person’s long-term health, could create a strong incentive to address social determinants of health and healthier lifestyle interventions.

      Align Payment Models Across Payers
      One model could be moving to a capitated payment model for hospital services so hospitals receive monthly payments for the availability of their services rather than be paid on a fee-for-service basis.

      Reduce the Administrative Burden of Risk Adjustment and Quality Measure Reporting
      Commercial, Medicare Advantage, and Medicaid payers should adopt the same patient attribution, quality metrics, and risk adjustment (when appropriate) methods as Medicare.

      Comment by: Don McCanne & Jim Kahn of PNHP: This Viewpoint proposes a set of innovations based on shoddy, non-existent, or discouraging data. One example is shared savings programs. like accountable care organizations. As we recently wrote, Medicare’s experiment with ACOs failed. Why continue it? And why shift to hospital capitation when the primary problem is prices, not utilization? And, if you’re looking for the big pot of gold, why not eliminate $800 billion in annual excess billing-related administrative costs that derives from the morass of insurance products and rules?

      The language used by the authors highlights the business orientation. Besides investors gambling on health-related bonds, they also mention bundling for specialists who agree to provide “parsimonious” care, making APMs more “attractive economically” for specialists, and, of course, the great overlooked potential of producing financial savings merely by “reversing” diabetes. Rather than basing the system on the opportunity to improve patient and population health, we should be developing systems catering to physician greed, they seem to suggest.

      One innovation they don’t advocate: proven unified health insurance systems that lower costs and lengthen lives. Like single payer. Why not? Because, as the authors’ affiliations indicate, their interest is in making money.

      Ah, marketplace innovations, they’ve worked so well for healthcare up to now, as we can all see. Clearly the best medicine is more of the same!

      Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

    • #443166
      djean111
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      They don’t emphasize a new diet, a new way of eating – they just start managing the symptoms caused by the fucking diet that causes the problem in the first place.  With, of course, pharmaceuticals.   It is fucking reversible if one cuts out sugar and starch and processed food.  At least for the first couple of years of diabetes 2.  But the treatments, the “managing”, never go there.    Any damned diabetes 2 treatment that emphasizes meds instead of cutting out the food that fucking caused it in the first place is a scam and a rip-off.

      That is a scary article.  Looks like we are headed for monetizing health outcomes, and here’s a thought – healthy people are not very fucking profitable for insurance and Pharma, are they.  Guess it is a toss-up – rake in ever increasing premiums from people who are healthy, vs raking in bigger and bigger profits from people with medical problems.   IMO there will never be health care for all as long as fucking capitalists run this country.  That’s Dems and the GOP.  Both fucking parties.

      America is not a country, it's just a business. (Brad Pitt, Killing Them Softly)

      Everything I post is just my opinion, and, honestly, I would love to be wrong.

      • #443500
        eridani
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        • Total Posts: 9,978

        –but are never fully effective, as I know from personal experience  Type II diabetes is genetic, period.  Insulin resistance, genetically caused, leads to weight gain in adulthood (at least in societies where most people have enough to eat most of the time) and diabetes if you live long enough–which people didn’t used to do in the olden days.  Insulin resistance is strongly favored in parts of the world most subject to famines, because it increases your survival potential and you are more likely to die from an infection anyway.  High fat foods are not a factor in diabetes, but high carb foods are.

        The world’s highest percentage of Type II diabetics exists among Pima Indians.  That’s because they now go to grocery stores instead of doing subsistence horticulture on land that is so dry that the crops fail 3 out of every 7 years.  They live much longer now though.

        As far as health care costs, in every age demographic, 5% of that demographic accounts for 50% of the total costs of that demographic, and 15% accounts for 85% of costs.  The healthy 85% are not a profit source now and never will be.

        Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

        • #443539
          djean111
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          • Total Posts: 6,436

          My rant about diabetes – my little brother (died in his twenties) had juvenile diabetes, back in the 50’s, terrible time, my dad’s job at the Sun Shipyard did not pay well and no insurance, he had to pay the doctor and take unpaid time off to get him to the doctor.  Needles, insulin, testing, we could only feed brother the eggs and whatever.  Anyway, bad times.  My son was diagnosed with type 2 in his forties, I put him on my no carb diet, his blood sugar went down to about 90, the doctor was amazed.  But son seems addicted to sugar, where I would be okay with never having sweets again – I like them, but never buy them for myself, don’t care about them, it is bread and pasta I love.  But that just makes me gain weight, my blood sugar has always been fine.   And I am quick to just stop eating them when I do gain weight.  Anyway, son’s doctor put him on meds and still okay to have sugar and carbs, wtf.   My son  never really understands that if his diet leads to high blood sugar, he must not just temporarily change his diet, he must permanently change his diet.  The meds are not a free pass.   Going back to whatever made one gain weight or be sick is never going to work.  IMO intermittent fasting is the way to go, more natural than three meals a day, anyway.

          Side note – my grandson’t mother has diabetes 1.  She does not much get involved with her son, my grandson, but told me I need to have him checked yearly because she has diabetes.  Well, the only way he would inherit that from her is if he also had an uncle who got into an accident with grandson in his truck and grandson’s pancreas was badly damaged and not working any more.  I am not sure she understands that, to this day.

          When I went to Australia, I was told that the aborigines had weight problems because of grocery stores, they had never had access to all that food before.  Very meager diet, the lack of food and necessary attention to genetics created intricate hierarchies of permitted intermarriage, twins were sent back to the cloud they considered they all came from, the portioning out of a kill was very complicated and cheating meant expulsion and the starvation, because hard to subsist on one’s own.  They also, because they had always shared everything, had problems with the capitalistic system wherein people could die from hunger right in front of a grocery store if they had no money.  Capitalism needs poor people.  Same with small food stores in under-served poor communities here – the stores cannot buy food in enough bulk to give lower prices, so access to good food is not the same as for people who can just drive to Publix or Whole Paycheck and just toss stuff into their carts.

          We could not find any ancestors with diabetes, but then perhaps it was not tested for or whatever back then.

          America is not a country, it's just a business. (Brad Pitt, Killing Them Softly)

          Everything I post is just my opinion, and, honestly, I would love to be wrong.

          • #443769
            eridani
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            • Total Posts: 9,978

            You are more likely to have it the farther away you live from large bodies of water which can yield fish.  Native Americans, originally from central and north Asia are very prone to diabetes if they spent a lot of time in environments like the Pima did.  Something that also strongly favors insulin resistance is that fat on women tends to give them the ability to have normal sized kids instead of kids that are too small and weak to survive.  NOBODY should be fucking blamed for  living in a society where getting enough to eat is the norm.  And guess what, going back to living in third world conditions isn’t going to do much for your life expectancy, even though you are highly unlikely to be fat or diabetic.

            Also, most modern jobs are sedentary, and those that aren’t are much more likely to give you repetitive strain injuries  rather than serious aerobic conditioning.  I had a highly privileged job as a scientist at a company that had an exercise room in the basement.  While I was setting up chro9matography runs and pop down there and get on the treadmill or lift weights while i waited for the baselines to get established.  The result was that I was able to postpone diabetic symptoms until well into my 60s.  My grandfather and father with the physiology I inherited died at age 46 and 59 respectively.  I’m still chugging along at age 75.

            It wasn’t only my privileged exercise situation that has gotten me this far, but also modern pharma and related medical technology.  A fairly cheap glucose meter allows me to calculate blood glucose and adjust my insulin doses very accurately.  The metformin helps too.  I do try to avoid simple sugars, but I refuse to get obsessive about other parts of my diet. Dad and grandpa were stuck with urine tests where they could find out about their glucose levels a week after peeing in a bottle instead of in 5 seconds.

            BTW, healthy lifestyles cause big increases in medical expenses.  Of the three of us, dad, grandpa and me, who do you think will wind up with the highest total lifetime medical expenses?  You get three guesses and the first two don’t count.

            Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

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