President-elect Donald Trump has not yet declared a comprehensive health care policy.
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As the country prepares for President Donald Trump's second term in office, there has been no in-depth discussion on health care. Nevertheless, improving the systems that make up 20 percent of our economy is as important as ever. Here are 10 actionable steps that can significantly improve the U.S. health care system by expanding access, reducing costs, and helping improve the health and well-being of millions of Americans. I will.
1) Medicare eligibility age
Every day, 11,000 Americans enroll in Medicare, many of whom have never used preventive medicine before. As a result, too much of our health care spending is spent on treating pre-existing conditions. One way to solve this problem is to lower the age of eligibility for Medicare to 55 years. This will bring an additional 3.45 million people into the health care system and provide them with routine preventive care that improves outcomes. And ultimately, this should be emphasized. , you save money. This would be a politically popular way of dealing with coverage for people who often have difficulty accessing it.
2) Antitrust enforcement
Between 1998 and 2021, there were 1,887 hospital mergers, and the number of hospitals nationwide decreased by 25%. Integration itself is not the problem, as long as care initiatives and prioritization of patient needs drive business decisions. However, a growing body of research shows that healthcare consolidation is leading to both higher costs and lower quality of care. The Trump administration may consider putting in place guardrails to ensure profit motives do not take precedence over reducing costs and improving outcomes.
3) Registration of multi-year plan
In government-sponsored plans like the Medicare Advantage (MA) plan where I work, people shop around every year and change plans based on benefits. With private insurance, you switch insurance companies and insurance plans every time you change jobs. The new administration could consider a new model of health insurance that would require people to keep their insurance plan for a certain period of time, but the plan could be moved between jobs and periods of unemployment. Under this arrangement, plans would receive incentives to keep large customer populations healthy and would be required to regularly report on patient population outcomes across a defined set of measures.
4) Medicare Advantage Brokers as Community Health Workers
New research shows trust in doctors and hospitals is declining. A good place to start rebuilding trust in healthcare is to use a healthcare broker. Brokers not only help clients choose a plan, but also help clients navigate the health care system, direct them to community resources, and promote healthy behaviors that can avoid the need for expensive medical care. We will also support you. Efforts to codify, standardize, and incentivize behaviors will ensure that these services become more than a nice-to-have, but a standard service that all brokers can expect.
5) Mandate standardized benefit design
One of the primary reasons Congress created the Medicare Advantage program was to introduce competition to the health care market. But in recent years, we've seen some plans go too far in their attempts to gain market share by designing benefits that do little to improve the health of their customers. For example, a recent high-profile plan provided pickleball paddles, fishing rods, and golf clubs to potential candidates. These benefits, while competitive, are of little use if you need long-term care. By adopting standardized plan benefits that are rooted in the provision of medical procedures, the federal government is allowing consumers to choose plans based on the health outcomes that matter most in their decision-making while MA can maintain competitive incentives in the industry. -Production process.
6) Focus on STAR ratings
MA star ratings often evaluate process rather than results. However, all health plans need to be able to tell potential customers how well their members are doing through common health milestones. We have solid data on what separates good care from great care in these and other important aspects, forcing plans to compete on how well they can manage the moments that matter. The incoming Trump administration may also consider varying broker fees based on a plan's STAR rating to encourage brokers to match Medicare beneficiaries with higher-performing plans.
7) Modification of risk adjustment
The Centers for Medicare and Medicaid Services (CMS) could use technology to determine risk coding in real time. Currently, CMS uses small-sample retrospective audits that examine unrepresentative data and spends resources tracking down outdated paper medical records to find diagnosis codes that do not match the actual cost of care for members. Requires planning. The government's corrective action if anomalies are detected is to require health plans to repay and fine. In the age of computerized data transmission and algorithmic data analysis, a better way forward may be to conduct faster audits so that health plans can quickly make corrections when problems are flagged. No.
8) National license
Under current state licensing systems, if you want to see a doctor in another state, you must go to that state. But in the age of telemedicine and virtual care, it should become easier for people to travel across state lines to see a doctor. Necessary federal reforms to this outdated state-based medical licensing system would also address the growing physician shortage and improve access to care in rural and underserved areas. Dew.
9) Solving the Utilization Management (UM) Challenge by Encouraging Headed Care
Lately, we've been hearing a lot about insurance companies using various utilization management methods to deny care. The power dynamic between payers and providers will change significantly with the global proliferation of capitation, a payment model in which providers receive a fee for managing all health care costs for plan members. . Capitation allows clinicians to control costs and make the investments necessary to do what's right for patients.
10) Motherhood Moonshot
The maternal mortality rate in the United States has skyrocketed due to the impact of the new coronavirus infection. According to CDC research, maternal deaths in 2021 were 40% higher than in 2020. The worst affected were women belonging to minority groups and women living in rural areas and small cities. One study attributes this increase to the pandemic's impact on social determinants of health. Whatever the cause, the United States currently has the highest maternal mortality rate in the developed world. Options to address this issue include requiring women to have Medicaid coverage for at least one year after giving birth, increasing funding for maternal mortality research, and community-based efforts to promote culturally appropriate and well-coordinated care. This includes expanding the program.
Not everyone will agree with this list, and these 10 ideas alone will not revolutionize the healthcare system. But you have to start somewhere. And in the absence of a clear health policy agenda for this country, those interested in improving health care in the United States need to start developing one.
