Medical Provider Wellness Incentives Save Lives and Boost Profits

Lower medical costs, better outcomes, happier Medicare beneficiaries, and greater benefits. Does this sound like an impossible dream of health care reform? It turns out it’s all happening now under a new wave of policies enacted by both the Biden and Trump administrations.

After decades of financial incentives that rewarded medical providers for subjecting people to a costly parade of procedures, we are now striving to focus on wellness, prevention and value.

These advances are taking place under an alphabetical soup of Medicare testing programs – with names including Accountable Care Organizations (ACO), Medicare Shared Savings Program (MSSP), Accountable Care Organizations Realizing Equity, Access and Community Health (ACO REACH) and Global and Professional Direct Contracting (GPDC) – but the philosophies are similar. They are moving care from the traditional fee-for-service model to one linked to health outcomes.

The healthier the patient or client, the greater the benefits to providers, rather than the perverse opposite that so often happens now. Healthcare providers must put their own skin in the game. We take on more risk in exchange for the possibility of greater reward. No middleman, no excuses.

I’m not going to pretend that this conversion is easy for healthcare providers, but I’m here to attest that it can work, even if the start can be difficult, as it was for us at Lifespark, to be honest .

We have been part of a value-based agreement in Minnesota between a healthcare system and the state’s largest Medicare Advantage provider for nearly four years. Yes, the first year we lost money and had to write a seven figure check when we didn’t meet our targets. But we have learned — and customers and taxpayers have benefited.

Since then, we have seen a 43% reduction in hospital admissions for our members in Minnesota and a 24% reduction in emergency room visits. Admissions to skilled nursing facilities have been cut nearly in half. At the same time, our Net Promoter Score, which measures customer satisfaction, is 93 out of 100, nearly three times higher than healthcare overall at 38 and more than double that of Disney at 44. Talk about a happy place.

Nationally, the Centers for Medicare and Medicaid Services (CMS) estimates that more than 11 million Medicare beneficiaries will be served by Shared Savings Program ACOs in 2022. Performance data continues to show high satisfaction in the elderly as well as savings for the system. In 2020, the most recent figures available, ACOs saved Medicare a collective $4.1 billion, an amount that was still an impressive $1.9 billion after ACOs were reimbursed for shared savings. .

It’s not to brag. That’s to say, it’s a game-changer, a change that can and does work for patients and providers. And let’s not forget the taxpayers who fund Medicare, which serves nearly 1 in 5 Americans and cannot continue to operate as an endless money pit. Just because people or consumers don’t always see a bill doesn’t mean someone isn’t paying it.

Of course, this requires investments: in data analysis, technology, personnel and above all in prevention and well-being. You must earn the trust of the people you serve by serving them well. Additionally, and I can’t stress this enough, you need to have strong relationships with like-minded people and providers, those who are aligned with the idea that the best healthcare is good health.

It might look like a numbers game. After all, healthcare spending represents more than 19% of the gross domestic product (GDP) of the United States. That’s a whopping $4.1 trillion, or $12,530 for every man, woman, and child.

But what it’s really about is serving people and keeping them healthy and out of hospitals as much as possible.

This new medical philosophy is to look at the total cost of care, which includes everything a person spends on their medical insurance, as well as all the out-of-pocket expenses they must use to live life on their terms, and how this care is provided. and to what end.

It’s about building delivery systems that view patients as full human beings rather than a heart bypass or sarcoma or any other medical condition being treated. It’s also about keeping people afloat financially – up to two-thirds of all personal bankruptcies are related to medical bills and illness.

We need to stop overserving patients and underserving them at the same time. We must assume the risk of investing in the prevention, maintenance, and enhancement of health, which Medicare today barely covers, if at all.

The risk for suppliers is great, but the opportunity is even greater. I say be bold. Let’s improve the consumer experience and help patients live a wonderful life. Let’s not even call it health care anymore. Let’s just call it health.

Joel Theisen, BSN, RN, is founder and CEO of spark of life, a Minnesota-based comprehensive senior health company. Follow him on Twitter: @Lifespark_CEO.

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