Within a Medicare HMO population, enhancing conservative care by listening to and treating the whole patient by trained specialists in rheumatology and sports medicine has been shown to reduce costs significantly.25
What patients say & believe are of equal importance to patient-centered care as their genetic make-up is to personalized care. Care cannot be recommended based on a population average.
Possible New Service Line Strategies & Offerings
Many discussions on listservs and at meetings are necessarily focused on fighting today’s battles while tossing out new ideas. A recent book I received from the RAND Corp., Redefining Healthcare Systems, by Robert H. Brook, MD, concludes with an essay, “Why Not Big Ideas and Big Interventions.” He asks 10 what-if questions, and I share four. What if:
- All communities had a health plan that promoted an environment in which all people could thrive and provided a totally integrated set of social and health services to aid people in need?
- Educational and health policies were replaced with people policies that targeted the interaction between health and education as the way to improve a community’s health?
- Many face-to-face physician visits were replaced by video encounters, encounters with computers and people in the community, or self-directed care—approaches that would be as effective as the traditional patient-clinician interaction but would lower costs?
- Medical expertise was shared so that by means of broadband Internet all people had immediate access, when needed, to world experts—without boarding a plane?
What if your rheumatology office offered a variety of new services with the intention of creating a new dialogue with insurers, employers and patients?
What if you designed and offered a two-month musculoskeletal consultation and care (MCC) package for patients being considered for surgery or expensive spine procedures? If it included initial consultations and up to two follow-up visits by you, a psychologist and a physical therapist, how much would you have to charge at a fixed rate to make this viable? Of course, you would need to include the face-to-face assessment, record review, care coordination and integration of other evaluations, phone and e-mail, and final report preparation time. As with research studies, an administrative overhead and program evaluation time would be built into the case fee, or for a fixed fee as a part of the annual contractual addendum. This is not an independent exam forced by the insurance company, but rather a new benefit they offer. Employers or insurers might incentivize patients to use this new care pathway by offering no co-pays.
