• What’s Cheaper?

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    “Diabetic care today costs insurers an average of about $30,000 a year, most of which goes toward treating expensive complications. An oft-cited example of today’s absurdist approach to health care is that many insurers will not reimburse $150 for someone to get a routine foot checkup, but nearly all will pay $30,000 for a foot amputation, an all-too-common remedy in advanced cases of diabetes.” according to BusinessWeek.

    HMOs had their day in the sun but their focus was on containing costs and restricting access. Since the introduction of widespread HMO use, health outcomes have not gotten substantially better nor have costs been contained in any meaningful way. A bright future is promised by Accountable Care Organizations (ACOs), a new model designed to reduce spending by improving health, eliminating inefficiencies and preventing costly complications. It sounds great but also sounds a little too good to be true.

    Imagine you were a diabetic whose doctor developed a customized plan to help keep the condition in check. Imagine a team that monitored blood sugars remotely and called you periodically to see how you felt. Imagine your doctor knowing when you experience a diabetic episode, with an appointment automatically scheduled to address it that day. Imagine seeking more intense treatment at a hospital whose staff already knew your history and could discuss follow-up care with your doctor. Here’s the best part: Imagine getting all this for less than you pay today. (continued on BW)

    ACOs are founded on two premises that make them unique:

    1. ACOs get paid for maintaining the good health of their “member subscribers” and rewarded for cost savings. They are not rewarded for consumption of services and medications
    2. ACOs require holistic care among all specialists and generalists with shared medical records and consultation that is designed to eliminate duplicate, and costly, procedures and provide better care.

    According to the Congressional Budget Office “up to 30 percent of all health-care dollars are wasted in unnecessary or duplicate care, with no corresponding benefits in outcome.” I can easily believe that statistic is true. The ideas underlying ACOs are great but the battle they have is all uphill.

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This entry was posted on April 1, 2011 at 2:44 am
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