Primary Care: The Concierge Model

“There are three basic goals for a National Health Care System; 1) keeping people healthy, 2) treating the sick and 30 protecting families against financial ruin from medical bills”, (Physicians for a National Health Program, 2016). No truer statement could there possibly be written or proclaimed as there is a crisis in healthcare costs across the United States. United States, one of the most developed western country, yet we suffer from – higher infant mortality rates, have shorter life spans and are affected by more chronic disease and or illness – than our contemporaries all while spending the most for insurance per capita and less annual doctor visits with less physicians, (OECD Health Data 2015). There is a question to be answered, “why”, why are we trailing our contemporaries and more important than that is, is our National Health Care system really working for us? The year 2010 was the beginning of change in the United States where we transitioned from primarily private insurance and welfare to a universal healthcare model, under President Obama with the signing into Law of the Affordable Health Care Act March of 2010. The purpose of the Affordable health care act is to ensure that all Americans have access to affordable healthcare, however in 2016 we are still questioning we’ve been successful based on funding, government sponsored healthcare programs, effects on the current HCO, elderly, military and accessibility.

Even though within the Managed care trends there have been many rapid transformations throughout the years with the HIPAA laws enforcements throughout health care facilities within the United States and Obamacare. Currently, there are challenges ahead with the healthcare reform due to the new presidency stirring up changes with health insurance and getting rid of Obamacare. Throughout the managed care trends chronic condition management have affected two-thirds of the baby boomer’s generation causing them to have chronic health conditions that them to receive medical treatment constantly with elevated health care cost. Next, a trend of having the options available for mobile health has grown tremendously by allowing many a chance to gain access

How does the design of the payment system affect individual’s choice of provider? How might Americans be reoriented to using primary care, rather than costlier services?

While our understanding has evolved with respect to certain advantages of MCO’s, our understanding of the disadvantages has also grown. This analysis will evaluate the use of MCO’s as a gatekeeper to controlling health care cost and offerings. It will evaluate the advantage MCO’s provide in a rapidly growing market due to the aging of baby boomers. The analysis will evaluate disadvantages that can arise with relying on MCO’s. These disadvantages work against the insurance company forcing a polarizing balance between how much control the MCO should retain over recommendation and provision of services.

Baby boomer aging is one of the large causative factors of this increase in demand (Glicken & Miller, 2013, p.1883-1889). According to Glicken & Miller (2013), the elderly population will nearly double in the next fifteen years putting a strain on the healthcare workforce. Also, more than half of physicians have intentions on limiting care access with regards to Medicare patients. Many medical doctors are refusing to care for Medicaid patients. This is a result of the growing number of individuals now with the means to afford healthcare due to the

One dominant economic feature of the healthcare industry is the growing need for both basic and specialized healthcare due to the continued aging of the “Baby Boomer” generation. This generation consists of over 79,000,000 individuals born in the US between 1946 and 1964. As this generation has aged, the need for healthcare has increased dramatically. Let us take a look at some statistics:

Primary care access is a growing concern for all Americans and the reason behind this concern is an imbalance between demand for care and capacity to provide care. Demand is growing as the population expands, ages, and faces chronic illnesses and the capacity is shrinking as the ration of primary care clinicians to population drops (Ghorob & Bodenheimer, 2012). A primary goal of the Affordable Care Act (ACA) was to improve access to quality health care for uninsured Americans, largely through public and private insurance expansions (Polsky et al, 2015). At the same time, the architects of the law recognized the need to increase the availability of primary care providers to meet the increased demand for health care (Pg. 538, 2015).

The Obamacare/ACA, might have helped numerous of individuals in acquiring health care, but the health professionals are facing a shortage of reimbursement difference for their services. As a result, Hospitals and healthcare providers were force to layoff personal and come up with innovative solutions. This point is proven by the renowned author, Amy Anderson by stating as follows: “The American health care framework has had shortages of personnel for quite some time and would not be prepared to give the adequate service to this amount of patients in need of medical attention. Training new professional health services personnel could take years. There is a shortage of graduates from medical and nursing schools. Doctors, nurses and health professional are sharing responsibilities prospective patients will face a longer wait time”. (Anderson, 2014)

The passage of the Affordable Care Act (ACA) has prompted policy makers and healthcare providers to review the current system of providing services to individuals and families. The previous system of providing healthcare services was impaired by inefficient systems that had elevated costs, waste of resources, and in some cases obstructions that prohibited individuals and families in seeking care in a timely manner. The goals of the ACA is to improve the health of the nation, increase quality of healthcare services, and reduce costs of the overall system while providing health insurance options to all people across the country. The health insurance exchanges provide options for all Americans to gain access to health insurance options, but

Depending on the illness and chronic conditions that the baby boomer generation will have, health care costs will rise to receive these services. The top 5 chronic conditions are hypertension, high cholesterol, diabetes, arthritis and obesity. It is the perception that gatekeeping reduces health care costs in the United States and it is a very effective strategy that exists today in most organizations. A dedicated primary care physician will take the time to spend with their patients to review their concerns and go over their basic preliminary findings such as blood pressure, weigh and personal issues as an attempt to build a relationship. Patients' satisfaction with and trust in their doctors will remain high only if the public believes the trusts are acting on their behalf, rather than making decisions in their own financial interests. In the United States, some of the harshest criticism of gatekeeping has resulted from the public's perception that medical decision making was unduly influenced by financial considerations (Forrest, 2003). Over 37 million baby boomers will experience having to manage more than one chronic condition by 2030 resulting in an annual cost of $13,000 annually (“American Hospital Association”, 2007). The forecasted costs for health care from a national perspective were $2579 in 2003 and will continue to rise 20 percent by 2030 (Martini,

As stated above, 11.4% of the population is still uninsured or under-insured. Of these patients, 40% have outstanding medical bills that will most likely go unpaid to the providers (3). This equated to $74.9 billion in 2013 of total uncompensated care across hospital systems and community providers (4). Not surprisingly, hospitals took the brunt of this cost at 60%, equaling $45 billion in uncompensated care. This raises the question of whether providers or other organizations can supplement the already subsidized monthly premiums. In theory, this model would be a win-win for the patient and provider, such that the patient stays covered and the provider is reimbursed for their

Even although, the cost of the health care system and the care it offers my not allow the national debt to decline to a level that will or would enhance the economy forward the cost of running a system that is backed by the government is too costly, and it will not help the deficit. , the legal responsibility of the organization is that every patron should have the same treatment for the same ailment. There are no predetermined dispositions; everyone is eligible as a government-backed facility. The funds are to assure those who have no insurance are covered. The accountable care

One of the greatest changes in healthcare in the past ten years has been the rise of managed care, much to the displeasure of many patients and physicians alike. Managed care arose out of concern about spiraling healthcare costs and was designed to encourage physicians to give patients treatments that were cost-effective out of their own financial interests. "The consumer strategy was directed at imposing some barriers to use by levying various forms of co-insurance. The most common approaches used either deductibles (where the consumer paid the first portion of the bill a technique familiar in other types of insurance) or co-payments (where the consumer paid a portion of the bill and the insurance company the rest) or a combination of both' (Kane et al 1994). Managed care has given health insurance companies an increasingly significant voice in how treatment is administered and allocated. Managed care has proliferated in the past decade despite considerable criticism of the practice of 'nickel and diming' patients as well as the considerable bureaucratic red tape it is has generated. Also, research indicates that healthy, well-insured patients tend to over-consume care without meaningful co-pays but poorer, sicker patients can be deterred even by moderate co-payments and suffer negative health consequences (Kane et al 1994). However, managed care has not gone away and is a reality that all healthcare

Managed care is and has been consider an effective approach to the quality of health care in America. There is a debate among health care professionals, government regulatory agencies, and the public on how best to reduce the ever escalating health care cost while delivering the best evidence based treatment methodology to our clients. However, with the recent implementation of the Affordable Health Care Act, many health care providers are presented with a daunting task of providing leading edge innovations to their patients within the regulatory restraints placed on them by this act. Also, the future trend of health care is more about accountability to the consumers through the utilization of the consumer driven health plans with emphasis on account Based Health Saving Plans and transparency. The major impact on the delivery of quality care will be that the Affordable Health Care Act and how it will affect how insurance payers implement cost containing restraints, adhere to governmental regulations, and while delivering the best evidence medicine to the clients they serve.

There has been a lot of talk and debate lately over Health Care Reform, as people are trying to answer the question – Should a universally accessible health care system be implemented in the United States (US)? This ongoing highly debatable issue remains a hot topic among US citizens from all walks of life, from the very poor to the very wealthy. Health Care Reform affects everyone. The vast majority of the US population is very dissatisfied with the current state of health care. According to the ABC News and Washington Post cooperative poll, 57 percent of Americans aren’t satisfied with the overall system of health care (Langer, 2009). Consequently, the issue of the Health Care Reform was born, but before analyzing the