Question

Evaluate these health care models:

• Managed Care - Competition
• Consumerism

What model, or hybrid model, would you recommend to maximize quality of care while controlling health care costs in the future? What would be components of a hybrid model? How could these models be used in ongoing development of the Patient Protection and Affordable Care Act?

Answer 1

A perfect hybrid model to maximize the quality of health care while controlling health care costs in the future should include the following -

1) Reduction of avoidable, ineffective and duplicate use of services including technology and encouraging clinically effective care based on comparative effectiveness research and implementation of information technology.

2) Payment for health care services and encouraging adoption of innovative models of health care delivery such as Patient Centered Medical Home.

3) Ensuring accurate pricing of services.

4) Ensuring an appropriate physician workforce.

5) Reduction of administrative costs.

6) Reduction of costs from medical malpractice and defensive medicine.

7) Promotion of wellness, prevention, chronic care management, changes in unhealthy behaviors and encourage patient responsibility for health and cost consciousness.

The uses of these models in ongoing development of the Patient Protection and Affordable Care Act can be observed in the following ways:

1) Provide all individuals refundable tax credits to buy health insurance.

2) Restructure and augment the Affordable Care Act's health care exchanges.

First, exchanges should be open to all individuals in the region served by the exchange and offer all health plans that meet coverage standards.

Second, the exchanges should correspond to the natural geographic market for the delivery of health care in a region,which might be larger or smaller than a particular state and might cross state lines.

3)Allow individuals to obtain insurance in a broad variety of ways like individual insurance market, public exchanges, private exchanges and employer based insurance.

4)Use refundable tax credits to eliminate the individual mandate. It would allow every individual to obtain health insurance at no out-of-pocket cost through enrolling in the most efficient, least expensive plan in his or her region that meets his or her family's needs and preferences.

5) Use public health exchanges to eliminate the employer mandate. It would provide every individuals access to purchase health insurance and the financial means to do so.

6) Risk-adjust premium revenue refers to health insurance plans that accepts all applicants at a uniform price.

7) Allow health insurance to be sold across state lines.

8) Lower regulatory barriers to encourage innovative and disruptive providers and approaches to health care delivery.

9) Create an organization to support and communicate research on what works in health care.