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With Managed Care receiving limited support from the masses this presidential election year, one has to wonder if the current PPACA (“Obamacare”) program will survive another year.
When the presidential race is over this coming fall, if either of the two most supported candidates is elected, there will more than likely be changes brewing in how to resolve the issues that hold our healthcare system ransom in the United States.
Same image, different rotations
For example, my personal speculation is that if Hillary Clinton get elected, that the attempts might be to continue riding upon the system already in place, under the claim that some things need improvement, and the financing needs for effective management and control, but in the long run, we will simply take what it now in place and change it to make it more effective, more consumer friendly.
If Donald Trump is elected, the resolutions formed in my mind are less convincing or indicative of attempts to maintain some status quo and stability. In the worst scenario, healthcare will be placed more into the hands of private businesses again, and those programs devoted to the underpriviledge lower class fortified as they have always beenm being available to those most needy, but considerably more thought our in terms of determining those who are eligible.
This means that in-migrating people will not easily acquire such coverage, those moving here for work related reasons, be it permanent or temporarily, will also have more “hoops” to jump through to earn their coverage. That will service the current system greatly, in terms of finances, but re-open old wounds as the previously uncovered masses, who briefly entered some sort of healthcare status under Obamacare, will once again be left to fend for themselves. Some of this impact can be lessened, with certain eligible members maintaining their eligibility due to such things as young mother and child status, or having to deal with some life threatening chronic diseases state. But the least qualified people who were fortunate enough t obtain coverage in recent years, may again be out of luck by the time a new program is put in place, should the next President-Elect be Donald Trump.
Fortunately, it will likely take one and a half to two years for any new health insurance managed care program to be implemented. That will lessen to brunt of change this nation might endure, whichever way we go.
Some evidence suggests that Hillary Clinton might opt to produce some formidable changes in the Obamacare plan, were she elected.
This begs the question:
What might the best changes be in such a system, were it to be established as an extension in the current program that exists, yet meet the financial and service industry needs in ho the newer way to manage care gets developed?
For one thing, eliminating “Obamacare” is easy. Change the program, get rid of that title that now has a tremendous amount of hatred and regret attached to it.
But we might only need to eliminate a very small of the PPACA plan in order to satisfy the public masses.
The most important elements to PPACA are the transfer, change and implementation of healthcare into a high technology supported industry, complete with information technology never perfected before by any single healthcare plan (and yes, none have perfected it, no matter how grandiose their thinking and self-judgment appears to be to colleagues).
The information technology systems in healthcare today, known specifically as health information technology or HIT (like this label avoids to scary innuendo of the title IT), are still struggling now more than 15 years into managed care, and nearly twenty years into their complete development and implementation.
Generation after generation of IT fears and barriers have surfaced and resurfaced, demonstrating that the healthcare insurance companies and masters of the health economics industry aren’t as wise or able as they want us to think. A change in technology occurs quite readily and in months to a year longer, through simple acceptance of the technology and willingness to test its application. But one could argue that insurance companies and businesses fear IT advancement due its financial impact upon their individual financial securities, and morality targeting impacts upon the leaders, people and companies that have to use this new technology.
Insurance companies lose considerably once they see solid evidence for overcharging (we can leave the fraudulent billers and overbillers out of this argument even). Insurance companies will lose greatly once their additional charges and unnecessary charges are uncovered. The waivering tendency for insurance to assign value and price to specific procedures will raise some red flags, more than they have been doing since this issue was described to the public several years ago–for example, why is the PET costing $175 for medicaid, but $675 for privately insured individuals?
With presidential-elect changes inevitable in the next year or two, how will IT itself — that skill set which insurance companies have failed to support or engage in — determine the lifespan of the long-lasting stubborn companies unwilling to engage in the EMR, EHR, IT, HIT, HITECH Act requirements used to define PPACA?
The truth is, these IT developments are here to stay, whether you like them or not. They have already demonstrated their value, and provided evidence to necessitate their further development and use in the healthcare billing and insurance industries. Even if meaningful measures lessen to some extent, leaders and common sense workers will not engage in lessening or reducing their production of proofs that changes are happening.
With IT/HIT development, we will learn more and more about effective and ineffective certain companies, programs, facilities, neighborhoods, insurance plans, mail pharma companies, allied health programs (bogus or not), and counseling and family support service agencies will be when included as part of the broader, long term minded, preventive-palliative healthcare programs many places are trying to develop.
So IT/HIT must stay for these companies to document, and brag about their successes.
Adding GIS to this only strengthens whatever arguments are going to be made, and making it easier to convince you audiences, in whatever direction you want.
What prevents spatial health work from becoming a part of the managed care system is not just lack of intellect about what it is and what it can do (everyone knows a map can portray, or lie). What prevents spatial health from becoming a part of the healthcare system is the lack of knowledge, desire, experience, and skillset on behalf of leaders, to put forth the option of developing such a program in order to save their own business significant amounts of money.
There are a few companies out there that are experimenting with spatial analysis.
But I have yet to see one inkling of evidence that any industry out there is able to analyze its entire popular for the 15,ooo ICDs and ICD groups, the 4 fold as many visits as patients, the 10 to 20 fold number of procedures these people engage in, for 10 to 20 years of long term EMR/EHR history held secure as part of the older medical records systems.
A few companies have 20+ years of EMR on file (I work for one). GIS demonstrates outcomes that these data produce, that no other MC can produce through much of the country. Likewise, insurance companies and health businesses that manage the insurance aspects as well, such as KP, have developed partially functional spatial analytic systems that may have the ability to perform full reporting for a full healthcare program.
The question is: what will be the first company to emerge that is able to create a full-fledged GIS/Spatial analysis based version of the QI improvement report, detailing thousands, not hundreds of the most important population health features?
These features must include the following:
- Human genomic data and disease history and spatial analysis
- Emergent/Urgent care data, past and present, in reference to age, gender, etc.
- Religious group data in relation to specific ICDs and medical events, compliance and non-compliance, and social and moral public health related disease or injury related risks
- Race-Ethnicity derived reviews of its regions and communities in relation to population health, place, economics, and cultural traditions.
- Socioeconomic status and predicted employment pattern related health care coverage, disease and success in relation to place, time and money
- Chronic Disease (CD) management databases, devoted to hundreds of CDs, engaging in predictive modeling of these costly populations
- Standard endemic disease pattern public health surveillance
- Atypical epidemic and foreign born disease patterns and travel in relation to local regional health matters (local Legionnaires, Ebola, Chikungunya, etc. types of studies and prediction models)
- The differentiation of standard linear versus hierarchical diffusion modeling behaviors and patterns pertaining to locally-specific disease patterns
- A remodeling of epidemiological transition theory to best meet the needs of the local populations being served, with specific attention paid to economics, business and health, using the sequent occupancy model proposed on other pages posted at this site.
This survey is developed to determine how ready the healthcare profession is for the spatial analysis of health and health-related costs by a managed care system.
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