To control medical spend, you need to start with Medicare and Medicaid.
On Medicaid, I would do two primary things. First, Id develop delivery models centered around PCMHs and highly integrate them with other specialties, including MH/SA. I would also add a reward system for appropriate management of conditions. Lets give people some financial incentive to manage their conditions. Cash works well. Some shared savings.
For Medicare, clearly expand bundled payments and move towards tiered reimbursement of docs based on outcomes (both cost/quality). I would ban medicare supplement policies. I would also include end of life counseling as a benefit. Last, everyone signing up for Medicare would be required to have a living will / HC POA.
On the private market, I would tax any benefit with higher value than a baseline HSA plan. I would require every physician to post their fees/disclose what things costs prior to treatment. I would also require there be some form of cost share on any service (sliding scale based on income). I would introduce the Medicare like cost/quality provider designations for consumers. I would create a high risk pool for folks with pre-ex conditions and allow insurers to underwrite and differentiate rating based on lifestyle choices. Id go as far as varying rates based on adherence to selected treatment protocols (diabetics who are well managed pay a lower rate).
That would be day 1...
On Medicaid, I would do two primary things. First, Id develop delivery models centered around PCMHs and highly integrate them with other specialties, including MH/SA. I would also add a reward system for appropriate management of conditions. Lets give people some financial incentive to manage their conditions. Cash works well. Some shared savings.
For Medicare, clearly expand bundled payments and move towards tiered reimbursement of docs based on outcomes (both cost/quality). I would ban medicare supplement policies. I would also include end of life counseling as a benefit. Last, everyone signing up for Medicare would be required to have a living will / HC POA.
On the private market, I would tax any benefit with higher value than a baseline HSA plan. I would require every physician to post their fees/disclose what things costs prior to treatment. I would also require there be some form of cost share on any service (sliding scale based on income). I would introduce the Medicare like cost/quality provider designations for consumers. I would create a high risk pool for folks with pre-ex conditions and allow insurers to underwrite and differentiate rating based on lifestyle choices. Id go as far as varying rates based on adherence to selected treatment protocols (diabetics who are well managed pay a lower rate).
That would be day 1...
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