Occupy health care


I am the 99%. And thank God for that. But it’s not what you think. This isn’t about radical politics and class warfare. I’m not looking to tax the 1%. I just want them to take better care of themselves. And I’m definitely not the only one. More and more, payers, insurers and big government are all looking at ways to get this group to live a little healthier. 

According to research from the IMS Institute for Healthcare Informatics, approximately 1% of patients generate more than 25% of all healthcare spending, with annual medical bills averaging about $100,000 a year.

And that’s just the sickest of them. In all, more than 7-of-10 privately insured individuals under the age of 65 years suffer from one or more chronic conditions. And as this group gets older and swells the ranks of Medicare in the years to come, the generations behind them are on track to set all new highs in chronic disease and healthcare spending. By 2030, it’s expected that half of America will be clinically obese and roughly 75 million people will have diabetes.

As the clock ticks away on a Supreme Court decision on the constitutionality of the Patient Protection and Affordable Care Act, it is becoming increasingly clear that whatever becomes of healthcare reform — whether you call it ObamaCare, RomneyCare or the Man-in-the-MoonCare — you can’t put the genie back in the bottle. There is growing acceptance that our current healthcare system is unsustainable. We save more by investing in keeping people healthy than we do by only paying when they get sick. We save more when people have insurance and access to appropriate sites of care than we do by ignoring them and allowing them to turn up in the ER. And if you make insurance companies accept all patients regardless of pre-existing conditions, it creates an incentive for insurance companies to manage that patient’s health more effectively — the only upside is in delivering better health outcomes. 

For a long time this was the vision for the future of health care. But there is growing evidence that the future is here.

For instance, take a look at the work retail clinics like MinuteClinic and Take Care are doing with Medicare. One aspect of the Affordable Care Act that has been in effect for about a year now, is the provision that allows seniors enrolled in Medicare Part B and Medicare Advantage plans a free annual preventive wellness visit. However, in the first year of the program, according to the Centers for Medicare and Medicaid Services, only about 6% of eligible seniors took advantage. The problem so far has been a combination of poor access and low awareness, two areas where the clinics can help. But the longer these programs continue, the more CMS and other payers will see other benefits of using retail clinics and the practitioners in them to their fullest potential — for about one-third the cost of a typical physician visit, you can help keep a chronically ill patient from falling into the ranks of the 1%. Because by then it costs 10 times as much to care for them.

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