Alicia Stokes Shares Healthcare Insights on Medicare Modernization, Food Security & Drug Pricing

Introduction:  

As we emerge from the COVID pandemic and embark on new realizations, caregiving has become even more significant when associated with service. Healthcare organizations are prioritizing the health and well-being of customers and communities. This includes focusing on the commercial space of healthcare, employer groups, and underwritten groups. The federal entities involved in healthcare are taking a keen interest in the Medicare and Medicaid space. Medicare and Medicaid space. Overall, the priority of providing better quality care comes with an obligation to explore multi-dimensional aspects and the needs of healthcare outcomes.   

The Progress of Medicare and Medicaid:  

Many opportunities to modernize Medicare and Medicaid have arisen. An increasing number of payers across the country are continually investing in this modernization. A significant development in this modern approach is the realization that health is more than just the physical care received at a clinic. It is the real integration between physical and behavioral health, along with a means to address other non-medical aspects of healthcare.   

Another avenue that is gaining attention is the community aspect of health. This is an analysis of the overall health of the community, wherein healthcare organizations view the health of the community as a whole, with a holistic approach rather than an individualistic one. This involves an understanding of the community’s needs, the current health infrastructure and organizations, and the means to partner with them to support care. An all-rounded approach can drive a significantly positive influence on the healthcare ecosystem.   

Drug Pricing:  

The challenge of drug pricing has never been as magnified as it is now. Since 2014, drug prices have increased by 33%, considerably outpacing other medical services. On average, 50% of members’ health spending is on drug costs. Within this scenario, specialty drugs constitute almost half of the pharmacy system spending. This is creating a disproportionate effect on Medicare and Medicaid patients.   

The first order of business to address the drug pricing challenge would be for payers to increase competition among pharma manufacturers. This will allow patients to negotiate lower prices, specifically for high-priced drugs that currently have little to no competition. Additionally, healthcare organizations must look toward increasing transparency and effectiveness of price points and other aspects of pharmaceuticals. The transparency should be analyzed based on its direct impact on consumer and provider utilization. Both these aspects can be achieved through the support of insurers for reforms. Innovation toward lowering direct members’ costs and creating specialty medicines at lower prices can deliver high savings for members.   

In reality, this approach towards innovation and transparency can translate very easily toward higher patient satisfaction and savings. For example, a patient with cancer comes to the pharmacy to buy their prescription drug. The pharmacist then informs the patient that there is a substitute drug with the same effectiveness but significantly less costly. It offers the patient a better alternative at the point of care that directly accounts for higher satisfaction. This information is subsequently transmitted back to the provider or primary care physician, who can then extend their corroboration toward the effectiveness of the substitute drug.   

Food Security:  

Statistically, only 20% of health outcomes are related to medical care, while the remaining 80% is connected to socio-economic, environmental, and other non-clinical health markers. These include housing, transportation, access to healthy food, etc. The recent pandemic has brought to light the extent to which these non-medical drivers can impact health and that the provider’s clinic is one very small aspect among the larger scheme of things.   

Healthcare organizations should address food security as the most commonly reported unmet social need. Innovative approaches should be applied toward effective and lasting strategies to drive the community towards healthier food and food security. This could include providing eligible members with a monthly amount stipulated towards fresh food, increasing awareness of healthy eating, etc. Programs devised toward supporting the intake of nutritious food and active enrollments can significantly impact community health and accessibility to food.   

Coming to community members who cannot afford nutritious food for their families. The numbers are very high. Even though there are several government programs and schemes in place to address this food insecurity, accessibility is a challenge that cannot be ignored. Payers must look for opportunities to build infrastructure and capacity within our community organizations, including funding, influencing, legislatures, and policies.   

Home Care:  

In the past, healthcare was focused on the physician’s clinic or hospital. Since the pandemic, the shift towards home care has been dramatic, to say the least. Accessibility has been a long-standing caregiving challenge, especially in rural and remote areas. The healthcare industry has been continually struggling to enable patients to make it for in-person care. This challenge seems to be mitigated with the rise of innovative technologies and healthcare programs that bring healthcare into the home.   

Through healthcare collaborations, primary care can now be delivered within the homes of chronically ill members. Through meal programs, patients who have been hospitalized in the past can get meals delivered to their doorstep. Moreover, patients can now receive physician advice and monitoring through telehealth services. Finally, there are facilities for members at risk of social isolation to receive companionship and assistance with everyday tasks. The healthcare industry has opened home health with zeal, and technologies are actively being developed to offer increasing services. Healthcare has gone beyond the doctor’s clinic; most care can now happen at home.   

Conclusion  

Telehealth solutions are now the calling of the future of healthcare. They are one innovation that can increase accessibility to caregiving, improve care quality, and decrease healthcare costs. With an estimated saving of $186 million over the next decade, healthcare companies are now taking a keen interest in innovations with telehealth solutions. A smart deployment strategy can prove instrumental in successful implementation and take the healthcare organization from strength to strength. Explore more interesting topics and listen to insightful podcasts related to healthcare only on CareTalk. 

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