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More balance needed between supply, demand

Publish date: APR 10, 2009



California community clinics are struggling to meet an increase in patient demand at the same time that their funding is declining, according to the Los Angeles Times. This represents the boiling point of a healthcare system that doesn't balance supply and demand of medical services, say experts.

“We can anticipate a movement of population from the high-end insurance products—PPO/HMO—onto the lower-cost ones—high deductible,” says Roy Schoenberg, MD, president and CEO, of American Well Corp.

The move will coincide with the growth of healthcare services consumed by those not under commercial insurance that either require emergency care or are covered by ballooning government programs like Medicaid.

“Both trends will direct attention to solutions that offset care from traditional—expensive—care settings to triage tiers that filter some of the traffic,” Dr. Schoenberg says. “The drive to develop and deploy such solutions will be fueled by two factors: cost considerations on one hand, and the fact that it will become more palatable—morally—to provide low-cost care even if it means quality compromises.”

In practice, plans and state operators will be required to suggest concrete solutions in two key areas in order to retain business:
• Technologies, such as call centers, telehealth or online care, that allow care to be coordinated and rendered without the patients showing up in expensive care settings, such as clinics, ERs and hospitals;
• Alternative care points that provide triage and low-level care, primarily utilizing non-MD staff such as workplace or retail clinics; and
• More advanced tools that facilitate self care, home care and home monitoring/examination.

This shift can be viewed as a rare opportunity for plans to expand their business into the retail domain where healthcare services are provided on demand for individuals who don’t have—or can’t afford—broad coverage products, according to Dr. Schoenberg.

“Plans can utilize their existing assets—brand, trust, provider networks—to introduce transactional services where non members can ‘be seen’ through one of the solution, for a low fee prior to showing up in higher-cost care settings,” he says. “Retail care offered by plans is exempt from much of the red tape bearing down on the traditional care delivery system and can reflect true value for consumers. Plans can adjust margins to reflect costs, and new revenue stream, and gain a much broader market share by touching more individuals than they ever had via their insurance products.”

As patient dissatisfaction grows with the U.S. healthcare system, consumers are shopping for value in all healthcare service areas.

Stand for Quality, a public-private coalition, has developed a quality-improvement and affordability framework.

Prescription drug trends show that the underinsured may be voluntarily opting out of compliance due to affordability issues. Lower copayments may be key to curbing this.

Health plan industry is trading at a discount so rumor of Aetna acquisition of Humana may not be far off base.

University of South Florida and Allscripts push paper-free prescribing while touting the availability of stimulus funding for e-health.


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