With the changing healthcare environment, the traditional silos of the healthcare system (e.g. payers vs. providers) no longer works. Whether these two typically opposing entities like it or not, they have to come together in order for the common goals of better healthcare and health outcomes along w/better quality and cost controls for everyone. As we all live longer and have to deal with more chronic versus acute conditions, payers and providers have had to ramp up their respective population health programs. In the past, it has been seen more from their particular vantage points from the payer/provider lens, but increasingly in shared-savings arrangements and landscape such as ACOs and Patient-Centered Medical Homes, these walls are coming down. Read here how some of this is happening.
Earlier this year, CVS announced it would stop selling tobacco-related products at all of it’s 7K plus stores nationwide. As of this morning, they have made good on their word. Unless it is to help a person stop smoking (such as Nicorette or the nicotine patch), no tobacco will be sold. At. All.
A few years back, CVS made the entry into being a health care provider when they opened up Minute Clinics, nurse practitioner/nurse run clinics to treat minor ailments in its’ stores. It has now grown to 900 locations. With new initiatives becoming more widespread such as Medical Homes and also Medical Neighborhoods, the business of wellness has bled (no pun intended) outside traditional brick and mortar providers. Seeing how the US spends more on healthcare expenditures than defense (that’s a whole lot of money, y’all), more and more for-profit entities are entering this field to try to get a piece of this huge pie.
What is next for CVS? Could they become an actual health system or even payer/provider like a Kaiser?
Patient-Centered Medical Homes (PCMH) are increasingly being looked at to coordinate care between disparate providers all for the purpose of better quality of care for the patient at a reduced cost. Think of it as having a central person (usually a nurse practitioner or a PCP) acting as the quarterback coordinating the patient’s healthcare needs. An article published in the Journal of the American Medical Association (JAMA) showed it was hard to show a direct connection to improved quality measures and controlling of costs. In this article, it goes into further detail in this controlled study published in JAMA as well as results from another PCMH where they have seen improved measures and controlling of costs in their participants.
A growing area in healthcare is the rise in alternative payment methodologies. Gone are the days of primarily fee-for-service medicine. The State of Colorado has recently published the results of an Accountable Care Collaborative (some folks may know this from the other name, Accountable Care Organization or ACO) in a legislative report. About half of their Medicaid members were enrolled in a Patient-Centered Medical Home where PCPs and dedicated case managers coordinated the medical care as well as non-medical care (e.g. transportation to doctor’s offices, homes sufficiently outfitted w/hand-rails if member is prone to falls). Result? The state saved approx. $44 million in 2012. However, the state invested around $38 million in total program costs including administrative fees. Hopefully, a good portion of these were up-front costs and the vast majority of these dollars should decrease in subsequent years.
Read more about this here.