Fair Trade and U.S. Healthcare
The concept of fair trade is relatively simple: an approach to business based on dialogue, transparency, and respect which ensures that everyone in involved in the creation and distribution of goods and services is paid a fair wage for products produced. To succeed in this approach, the products are accurately priced at fair market value.
The United States spends $2.5 trillion on healthcare -- twice as much as the entire nation spends on food. It’s no secret that healthcare prices in the United States generally reflect a provider’s market power, not the quality of care from the provider. Privatized health care creates massive price variations for medical procedures. For example, in a single health plan, the cost of a colonoscopy can range from $563 to $3,967. A simple x-ray can range from as little as $27 to as much as $143.
Though higher prices are not in any way directly correlated with better quality of care or more favorable health outcomes, most consumers continue to needlessly pay more for their health care, despite economic hardship.
Hospitals and Market Dominance
First, no one is trying to equate the socioeconomic status and challenges of a health care worker in the United States with those of a slave in the West African cocoa trade. Simply the concept of fair trade is applicable to healthcare in the U.S.
Just as dominance impacts pricing in unregulated markets, it also directly impacts pricing in U.S. healthcare. There is no greater example of this than the stranglehold that hospitals have on independent private practices.
Health insurers and pharmaceutical companies are often depicted as the sole source of healthcare’s hyperinflation, however a majority of healthcare spending is done at hospitals and health system-owned practices.
These hospitals with large balance sheets -- in the billions -- stifle competition with the threat of slander and lawsuits against smaller independent private practices, sometimes threatening to open up clinics next door, freezing them out of both referrals and operating rooms, and even going so far as to report them to the state to bury their practice in paperwork, slow down their efficiency, and add to their overhead.
It’s no wonder that 9 in 10 physicians are unwilling to recommend the profession to others and that the United States is facing a 90,000 doctor shortage by 2025.
Putting an end to these monopolizing business practices would foster competition. Ethical business practices combined with transparency in pricing would drive down healthcare costs and allow healthcare professionals to benefit from higher wages and a quality work environment -- in turn, benefitting the patients they treat.
How Lack of Transparency in Healthcare Affects Quality of Care
Though Americans are paying a premium for health care services, they are not receiving a higher quality of care. While many patients often don’t receive medically necessary care, others receive care that me be completely unnecessary, or even harmful. In fact, the United States consistently ranks dead last among other wealthy countries when it comes to quality of healthcare.
Specifically, the United States rank far behind the UK, Germany, Switzerland, and New Zealand when it comes to:
- Quality of Care
- Access / Healthy Lives
"Adults in the United States are far more likely than those in other countries to go without needed care because of costs and to struggle to afford basic necessities such as housing and healthy food,” The Commonwealth Fund reports in their annual 11-country survey.
Pricing transparency in health care will lead to more competitive pricing, which would allow both payer and patients to receive greater value for their money. By providing consumers with transparent, comprehensive price and cost analysis, they will have all the necessary information to make better, informed decisions about their health care.
Despite the health care crisis, many well-organized practitioner groups, hospitals, and insurers have proven that providing high-quality care at much lower costs can be done. It can be done by data-driven organizations that have the ability to understand and track all of the elements of care, including price and outcome, and consistently strive to improve by creating benchmarks for success.
Oculus Health: Transparency for Patients, Fair Pay for Doctors
Oculus Health developed Transitional Care Management (TCM) for doctors and independent primary care practices who are bogged down by the slow adoption of modern care delivery and payment models. Medicare has created several targeted programs that leverage primary care providers as a means to address the population health disparities associated with chronic diseases.
Under these new programs -- Comprehensive Primary Care Plus (CPC+), Medicare Access and CHIP Reauthorization Act (MACRA), and Chronic Care Management (CCM) -- doctors are both reimbursed through incentivised payments. Under these alternative payment models, primary care practices have financial flexibility based on performance in these key areas:
- Quality of Care
- Resource Use
- Clinical Practice Improvement Activities
- Use of an Electronic Health Record System
Does this look familiar? Remember The Commonwealth Fund’s annual report detailing where the U.S. ranks among other wealthy nations in quality of care? Let’s take a look.
U.S. consistently ranks poorly in...
Practices are rewarded based on...
Physicians must report all required measures to be properly scored for their performance and reimbursed. This requires a the use of an electronic health record system and transparency.
Oculus Health works with primary care practices’ existing workflows to combine technology and decision support to produce care models that virtually eliminate manual processes. Fulfilling Medicare’s requirements for performance-based incentives is effortless with ease of documentation and reporting, providing an improved patient-provider experience and tremendously reducing the cost of care.
With Oculus Health and Transitional Care Management, providers can:
- Provide comprehensive data tracking, querying options, and reporting capabilities
- Provide 24/7 accessibility management services through enhanced remote communication capabilities
- Provide support for continuity of care management
- Provide support for the coordination of care
- Provide the ability to create comprehensive patient-centered care plans
- Provide the ability to manage transition care
By equipping private practices with the tools they need to be effectively transparent in their activities, they are able to be properly compensated, grow their business, serve more patients, and provide better quality of care.
Oculus Health enhances primary care delivery and puts quality, accessible health care in the hands of more patients in the United States. Learn more about what you can do to achieve excellence in healthcare at www.oculushealth.com.