What People Get Wrong About Healing Medicare

The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

By Debbie Finnel, Chief Executive Officer

The current Medicare healthcare system is broken. It incentivizes the wrong actions. It benefits those looking to make a profit while it bulldozes over the people it purports to care for. The current system does not benefit taxpayers, beneficiaries, or healthcare providers.

Some say fee-for-service (FFS) care is the solution; it isn’t. But what we do at ilumed can heal healthcare.

How the healthcare system broke down

Many say private insurers and pharmaceutical companies are to blame for the state of Medicare today, but that doesn’t paint the full picture. Back in the 1980s, primary care physicians (PCPs) spent their lunch breaks doing rounds at the hospital, visiting their patients who were hospitalized, keeping their finger on the pulse of their care. If they had patients living in skilled nursing facilities (SNFs), they called those facilities at the end of each day. They took responsibility for their patients’ care no matter where they were. They were the connection for their patients.

But over the years, the system became fragmented and siloed. The hospitalists and intensivists didn’t know what the PCPs were doing and vice versa. PCPs got cut off from the patient. As a result, they started picking up more patients for their panels, spawning the churn-and-burn situation of today. The average PCP exam lasts 18 minutes according to a School of Public Health at the University of Minnesota study, yet longer appointments are critical for clinically complex patients—like many Medicare beneficiaries who have one or more chronic conditions.

The rise of specialists coincided with these industry shifts. Doctors fresh out of med school saw they could make more money as specialists. As a result, patients started seeing a cardiologist, a pulmonologist, a nephrologist separately. No provider was connecting the dots. Patients were on their own to navigate not only the system but their various treatments. The prescriptions stacked up as did the adverse medication events.

FFS care is not the answer

Some claim FFS is the way to keep Medicare solvent. But the truth is, FFS doesn’t solve Medicare’s solvency problems because it’s not trying to solve the root issue: sicker people living longer and requiring more complex care.

FFS patients are left to navigate an increasingly complex system on their own. Their health is not improving. They’re not paying less for the care they do receive. In fact, the opposite is happening. And it’s all because of the erosion of a fundamental relationship: the PCP and patient. FFS doesn’t incentivize doctors to think holistically or preventively. It doesn’t give providers the tools to treat the most at-risk patients and address their underlying barriers to health. At best, FFS is a Band-Aid reaction. At worst, it exacerbates silos and causes more fragmentation in the system.

Putting patients first

We need to get back to the PCP as the central point of a patient’s care. We need to empower them to become more hands-on. We need PCPs to develop deep relationships with their patients, to know the names of their patients’ grandkids and dogs. We need to give them the tools they need to help those most in need. We need to make the PCP the glue for the entire system. We need to give PCPs the ultimate responsibility for caring for their patients, wherever they are in the care continuum, to work with the hospitals and SNFs and in-home care providers rather than in siloes. We need to put the patients and their health outcomes first so we can move in the right direction. We need to get back to good old-fashioned care with a personal touch. And that’s exactly what ilumed does.

Yesterday’s approach, today’s technology

In the past, a high-touch PCP model meant lots of driving and phone calls. It also meant three-ring binders. Back when I worked in a medical office, I kept color-coded binders. The red one was for the people who didn’t take their medications and their conditions got worse. How did we know? We had their prescriptions sent to the office for patient convenience.  Yet the unclaimed bottles stacked up. The doctors’ eyes opened when they saw how few patients took their medications as prescribed. While it was analog, we had the data we needed to act. We could identify those people who needed more attention and education.

Today, we don’t need our PCPs to do rounds at the hospital or create a color-coded binder system because we have data platforms, like ilumed’s BrainStream, that can stratify patients by risk. We can remove the busy work and focus on the real work for patients that improves their day-to-day lives. We can get them connected to a food bank that delivers if they’re struggling with food security. We can offer them transportation to and from the doctor if they struggle with mobility or lack transportation. We can connect them to mental health professionals if they’re struggling with social isolation and/or loneliness. Can FFS do that? No. If you ask me, FFS simply disenfranchises patients more than they already are.

Hard work deserves the right compensation

In the movie Beatriz at Dinner, Beatriz (played by Salma Hayek) says to her dinner host, “You can break something in two seconds. But it can take forever to fix it.” Healing healthcare is hard. It takes time. But ilumed is doing it one provider at a time. It takes effort to turn around decades-long habits and break down siloes. Helping patients live their best lives takes dedication and creativity because no two people’s best lives are the same.

Transitioning from a transactional, FFS care model to a value-based model takes time and demands that providers and patients become more accountable and engaged. The ilumed model is not a get-rich scheme, but rather a recalibration and recognition of hard and effective work done by people who put patients first.

Our vision

At ilumed we have a saying: when you know better, do better. For decades, we’ve been learning how to improve healthcare. We’ve been testing new approaches and developing new technologies. We have a plan to eliminate healthcare’s most harmful siloes and the track record to prove our approach works. Our mission is to illuminate medicine by uniting clinicians focused on delivering healthcare with empathy and compassion. We believe our gifts can shine a light on the power and possibilities of personal, holistic care. We’re doing better. I ask the Medicare industry; will you join us?

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