Should the U.S Healthcare delivery system be restructured?

The new trend adopted by the retail and pharmacy blockbuster chains means there will be express and retail clinics that have new partnerships with commercial insurers. Through this, they can expand their patient outreach and improve their bottom line while repositioning themselves as the new ‘front door’ of providing primary care. The proposed purchase of CVS Healthcare by Aetna and the purchase of Humana by Walmart are examples of such a trend. At the same time, these ventures of pharmacies and retail blockbuster chains can be seen by the commercial insurers as their avenues through which they can continue their diligent advances of diversification. If there is no action taken as of now, such ventures will soon be dictating the entire U.S healthcare delivery system in the future. This venture does sound great when you hear about it. It means that healthcare would be readily available and be ‘just around the corner’ for each patient. There are however, quite a few drawbacks of these acquisitions which need to be understood and then addressed accordingly. Some issues that must be addressed are:

  • Do we really want to have an insurer or pharmacy monolith be in absolute power so that they can steer patients to certain facilities and providers for services, healthcare and medicines? After the primary care, the patients may sometimes require specialty care as well with coordination across the continuum of health services. There are only a small number of mergers which have been proposed so far, which include the multispecialty provider groups – such as the proposed acquisition of the DaVita by Optum. This must be considered, whether it is on the radar of the company or not and if it is, then what are their proposals for a complete and thorough system of care delivery?
  • How will they be affecting the supply of the primary healthcare providers? It is not possible to be efficient or realize economies of scale by simply having just one or two clinicians in a retail pharmacy at every nook and corner of America, where they will be competing with each other. This may make the primary care providers even scarcer than they already are and they may see only a few patients every single day. The companies should be clear about how many such primary care clinicians they will be having over a broad geographical area.

The points above are just a few considerations which must be addressed while these business acquisitions are still in infancy and at the proposal stage. The focus should be placed on what impact that these acquisitions may have on the patient access and on the structure and the overall health care delivery all over the country, rather than simply talking about the financing arrangements of these acquisitions. There is no doubt that a disruptive innovation is much required in the healthcare market in the USA. This disruption, however should be applicable to the US healthcare delivery system’s structure itself and it should be able to address how to have healthier communities and to deal with patients on an ongoing basis. For example, picture a recent regionally-based model of healthcare where the patients consist of those who live and work in a particular geographical area. Where would be the best place for such patients to receive their health care? Which providers would be most needed to provide such a care? How can the access of patients be expanded, while at the same time, reducing the cost of such a healthcare? How can this healthcare be integrated into the daily lives of people? Another important question is: What would be the features of a new, improved and an innovative healthcare delivery system in the US? It can certainly adopt some of the following features:

  • People who are living and working in a particular area should be receiving their care from a designated health care delivery system.
  • Patients should receive their health care locally in the area and the specialty care services regionally. The more complex health care procedures however should be performed only in some well established and professional centers which are located throughout the country.
  • Healthcare delivery system based on regions should be incentivized to improve and maintain the health, wellness and the fitness of the people. Financial incentives or certain subsidies may be paid to the systems for such an initiative (rather than directly to the commercial insurers or the patients).
  • Patients should be able to purchase the healthcare insurance directly from their regional system of healthcare, which will help to integrate the delivery and the financing of the healthcare and also align the incentives.

These options would help to reinforce the accountable care organization and would also expand the coordinated care, technologies and the services. The focus of the debate should be changed from financing the health care system (change or tweak the Affordable Care Act which only talks about the subsidies) and put more focus on the construction of the most effective health care delivery which should be accessible to each patient to improve the overall popular health. We should work to restructure our healthcare delivery system in order to include all types of healthcare services and not just the primary care, before we have a new medical market place which is simply led by the commercial insurers and pharmacy chains. Through the innovation and the disruption of the health care delivery chains, we may be able to expand the reach of the patient access and be able to improve the quality as well, which will reduce the total cost of care for the patients and also improve the health and the wellness of every American citizen.