As this Republican Congress works with the president to tackle the issue of healthcare cost and coverage, it is important that we don’t repeat the mistakes from eight years ago. We must prioritize getting it right over getting it done quickly. If we want to lower the cost of health insurance for American families, we have to lower the cost of healthcare – this requires identifying the sources of the high cost.
Consider: Five percent of Medicaid patients account for 55 percent of all Medicaid costs; a Kaiser study found that 10 percent of patients account for two-thirds of healthcare costs in our nation; recently, Maryland identified 37 million in healthcare dollars were spent on just 500 patients. Some of these patients have chronic complicated diseases, some have short-term needs such as a pregnancy. Ultimately, all need healthcare, but care doesn’t have to cost the patients, the government or employers as much as it does today.
Many patients are “over utilizers” in that they use a lot of expensive healthcare services because they have health conditions that could have been prevented or are complicated from poor-quality treatments. Merely increasing copays and deductibles, which occurred under the Affordable Care Act, won’t prevent a patient from being taken to an emergency room or be hospitalized for serious problems; in fact, higher copays and deductibles are often barriers for these patients to receive the care that would have prevented the emergency department visit.
Instead of charging patients more for treatment when they have health problems, we should pay healthcare providers to help patients stay healthy and manage their health problems more effectively. One major opportunity for doing that is to break down the payment walls between physical and behavioral medicine and enable physicians to deliver better-coordinated, patient-centered care integrating physical and behavioral medicine.
Seventy-four percent of patients with a mental illness have at least one chronic health condition, 50 percent have two or more. New evidence shows that schizophrenia alone, often in the absence of other known diabetes risk factors, is associated with a significant risk of diabetes. Thirty-three percent of heart attack patients will develop depression, and similar links have been found between depression and cancer, stroke, chronic pain, hypothyroidism, and arthritis. Failing to treat both depression and the physical problem in a coordinated way doubles the total cost of care. Studies consistently show a savings that run between 20 and 50 percent for over utilizers under an integrated/coordinated model of care.
For example, rather than assuming a patient with diabetes needs help only from an endocrinologist, some primary care physicians proactively screen newly diagnosed patients for depression followed immediately with a referral to a mental health professional when appropriate. Additional complications (thus, additional costs) can be prevented and treatment compliance increased with this proactive, integrated approach to care. In like manner, doctors who treat patients with chronic back pain and diagnose alternative pain management strategies saw a 30 percent reduction in spine surgery.
There are many other examples around the country in which proactive care management has helped patients with asthma, cancer, heart disease, Inflammatory Bowel Disease, chronic migraine, and other conditions to receive better care at lower cost. To be effective, physicians, nurses, psychologists and other medical professionals need the flexibility to have phone, email and other communications between providers and patients to address patients’ questions on symptoms and medications as expeditiously as possible. Unfortunately, Medicare, Medicaid, and many health plans don’t pay for these high-value services, and they end up spending more to treat problems after they occur.
There are also federal policies that prevent sharing the information that could help ensure patients receive the treatments they need. For example, the opioid crisis in this country has taken too many lives. By law, a physician is often totally blind to any history of the patient’s addiction disorder or treatment because of federal regulations 42 CFR Part 2. While listing of drug allergies, for example, is allowed, the federal regulations prohibit opioid addiction data from the medical record without signed permission for each disclosure to each provider. The physician is often unaware and cannot coordinate care with the addiction counselor and a patient leading to errors such as prescribing of opioids that result in a relapse and in some cases death.
Access to health insurance coverage is a hollow promise if that insurance isn’t affordable. We need to make major changes in our current fee-for-service payment system and regulations that will enable more coordinated and integrated care for all of our citizens, rich and poor, young and old. Reforming healthcare payment and delivery, as well as insurance, will prevent many tragedies while also saving our nation’s healthcare system $500 billion over the next decade.
Tim Murphy, a Republican, is a U.S. representative from Pennsylvania and a psychologist in the Navy Reserve Medical Service Corps. Thinking of submitting an op-ed to the Washington Examiner? Be sure to read our guidelines on submissions.
