If the pandemic has taught us one thing, it’s the importance of health care. Just as the Bubonic Plague opened the door to the Renaissance, COVID could usher in a new model of significantly elevated wellness and health economics.
For two decades I’ve been on hospital boards, observing the challenges of our national health system. Now, after personally interviewing over 100 leading health care CEOs, the problem is becoming clear: The current incentive system is actually backwards. It favors services rendered in hospitals by reacting to illness instead of preventing it and creating wellness. With advanced technologies in place, once we align payment systems to focus on preventative and home-based care, we can build the powerful healthcare system of the future.
This is a two-part solution: We must focus on preventative health and embrace moving health care out of the hospital–and more to the home.
Preventative care is the what
Dave Hickey, the president of BD Life Sciences, has identified the key trends that are driving the future of health care as: “developing smart, connected care technology; enabling new care settings; and improving chronic disease outcomes.” Chronic diseases are a great place to start because they are the leading causes of death, illness, and disability in the United States–as well as being responsible for 86% of our nation’s $4.1 trillion annual health care costs.
As Mike Alkire, the president and CEO of Premier Inc. aptly outlines, “At the end of the day, you can’t have a focus on prevention and wellness if you only pay for curing illness. The economic structure of preventative care must be consistent throughout the entire care continuum–from retail clinics to hospitals to the home and everything in between.”
For too long, the interests of key players in that continuum–patients, government, insurance companies, and hospitals–have been misaligned. That mindset is changing, starting with the insurance industry.
“From an insurance perspective, we know the extraordinary value of preventative care, particularly when dealing with potentially catastrophic challenges like cancer or heart disease. From a human perspective, we know that the chances of survival rise exponentially with early detection. We also know that from a financial outlook, preventing a disease is a lot less costly than treating one for both the patient and insurance carrier,” Virgil Miller, the president of Aflac U.S., told me.
Additionally, Senate and House committee leaders can start realigning payment structures and advancing legislation to restructure the economics of health care to focus on prevention and wellness.
Key societal elements of prevention could be targeted with practical solutions, BD’s Dave Hickey pointed out. “Racial and ethnic minorities, rural residents, sexual and gender minorities, and those with limited English proficiency often face cultural, economic, and geographical factors that preclude them from obtaining critical health screenings, including Pap and HPV tests,” he said.
Home-based health care is the where
Preventative health can often be best served by shifting from a hospital to a home setting, which not only improves the economics, but also dramatically elevates well-being.
“To truly transform health care, we need to focus less on what happens in care settings and more on what happens where people live their lives. We need to explore ways such as the Planetree person-centered care framework which can help healthcare providers make practical operational improvements to integrate healthcare seamlessly into peoples’ lives and address what matters most to people to make it as easy as possible to adopt healthy behaviors,” says Patrick Charmel, the CEO of Griffin Health Services Corporation.
Just as the pandemic has shown that workers often prefer being home, patients often prefer being at home as well. A recent survey on post-acute care showed that 86% of adults preferred to receive post-hospital, short-term health care at home. And this trend is increasing. In fact, through 2028, the Centers for Medicare and Medicaid Services estimates that home health expenditures reach $201 billion, up 73% from 2020.
“Success for healthcare is meeting patients where they are and easing their way to wellness. Virtual nursing care and hospital at home will be supportive of patients and allow health systems to reimagine how care is delivered. An added benefit is that will also have a significant positive impact on caregiver burnout and other workforce shortages,” says Erik Wexler, the president and chief operating officer of Providence.
In summary, if we can just change our mindsets and flip reimbursement policies, we can save billions of dollars on health care every year while enhancing our wellness.
Robert Reiss is the founder and CEO of The CEO Forum Group.
The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.
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