From innovative laws and regulations to the development and rollout of new best practices, healthcare in America is rapidly evolving and the industry is transforming dramatically as a result.
The catalyst for healthcare’s change has been the Affordable Care Act (ACA), introduced in 2010. The ACA has spawned new concepts and frameworks that are reorganizing care delivery to provide for more efficient, effective, and high-quality healthcare. While the proposed strategies for redesigning care vary, one key feature is present in all the emergent models—prevention.
New Models, New Approaches
Prior to the introduction of the ACA, prevention had been relegated to the backburner of healthcare. In the past, the U.S. devoted less than 9% of its total health expenditure towards disease prevention. Further, under the old fee-for-service model, patients looked for care when they were already sick, and providers were only reimbursed for the services they provided. Patients were not incentivized to be healthy and providers were not incentivized to keep their patient population healthy. Now, new models of healthcare delivery, such as the Patient Centered Medical Home (PCMH) and Accountable Care Organization (ACO), are attempting to change this. The redesign, shifting from fee-for-service to value-based care, is bringing prevention to the forefront once again.
The Extension of Prevention
As part of population health management, prevention has been identified as a means to not only deliver better care and produce better outcomes, but also reduce the price tag of caring for complex conditions. As a result, many healthcare systems and insurance providers have begun to provide better care management and wellness initiatives, particularly for those with known social determinants of health. The behavioral, social and environmental factors have a major impact on an individual’s health, and multiple studies have noted that how we address social determinants has a large impact on outcomes, costs and the creation of health disparities. Thus, the value in investing in “nonclinical primary prevention” has been made apparent.
Breaking With Tradition
Not only are more providers and insurance companies providing better prevention, they are breaking the mold of what we have thought to be traditional healthcare and preventative tactics. For instance, a prescription for food is certainly not the normal script. However, at Boston Medical Center, physicians in the center’s emergency department and at their more than 20 clinics every day write prescriptions for patients to receive food. Those struggling from food insecurity are sent to the facility’s on-site Preventative Food Pantry. The organization provides enough “medically and culturally appropriate food” for the patient and their entire family. Patients can return twice a month to receive more food as long as they continue to receive care from a BMC provider. In total, this “food pharmacy” serves more than 7,000 people each month.
A health plan covering its members’ GED certificates isn’t the norm either, but it is exactly what one insurance company plans to do next year. Beginning January 1, 2016, WellCare Health Plans will offer free GED testing to its eligible Medicaid members as part of its ‘Ohana Health Plan. As Pamme Taylor, WellCare's vice president for advocacy and community-based programs said, “People cannot prioritize their health when their basic social needs are not being met.” WellCare believes by helping members achieve higher levels of education, it will result in higher paying jobs and increased health literacy, ultimately reducing barriers to care and leading to healthier lives.
When looking at what shapes health, the social determinants cannot be ignored. Whether it’s housing, food, work, education or medical health, more plans and hospitals are looking to provide better preventative care for their community and patient population. U.S. medical care is reinventing the norm and breaking the mold of traditional prevention.