Question

You have been hired by the Chief of Staff for President James of Desiland to consult and provide a plan on how to improve healthcare infrastructure for this country. Desiland is a nation of 100 million people with an annual GDP of 1 trillion U.S dollars reported in 2018. The annual healthcare expense for this nation is 3% of its GDP.

The political environment is similar to the U.S. Although there are 6 political parties, there are 2 main parties; a liberal party and a conservative party that control the congress. President James is an independent and a reformer who has wowed to work for the people rather than to promote any political party’s agenda.

The current healthcare environment with Desiland is as follows:

• There is a government plan that pays for indigent people who earn < $15000/yr. and provides assistance with catastrophe care coverage for emergencies and pregnant women. This plan also provides coverage for seniors who are > 65 years of age, but there are serious gaps in care. Seniors don’t have coverage to see primary care practitioners or specialists in ambulatory care settings, and they cannot afford prescription drugs either. Disabled people only have limited catastrophe plan coverage that covers emergencies and inpatient hospitalization.

• There are approximately 10 private insurance companies that provide various plans available at different prices for those who can afford.

• There are approximately 10 million people who are uninsured, but they are working, and they have annual incomes > $15000 and < $50000 per individual, and > $15000 and < $114000/ family of 4.

• Approximately 2 million people are undocumented workers who do not have any insurance, and they frequently access emergency services which is high cost to the hospitals.

• Approximately 500000 people are migrant farm workers from other countries or refugees and they are all uninsured.

• Approximately 3 million native desi people, who are protected by the Desiland federal government, and they have special carve out funds available from the Desiland federal insurance plan. However, the funding is inadequate to cover preventive health costs and outpatient care costs.

• There’s a network of government and private hospitals and clinics, but lack of access and sub-standard quality of care remain as major issues.

President James would like the following in your proposal:

• Healthcare coverage for all

• Improved quality of care with full accountability for clinical, financial, process and social outcomes.

• Value based care

• Improved access

• Lower cost (affordability)

• Improved patient satisfaction

• Improved provider satisfaction

• Implementation of a population health model that clearly outlines the determinants of health that need to be addressed through upstream, midstream and downstream interventions and measures to see if the interventions are effective.

Please explicitly describe how the aforementioned requirements will be achieved. Be sure to provide details of how everything will be funded and implemented.

Points that Need to be Covered: » Healthcare coverage for al » Improved quality of care with full accountability for clinical, financial, process and social o outcomes. . Value based care . Improved access . Lower cost (affordability) . Improved patient satisfaction Improved provider satisfaction . Implementation of a population health model that clearly outlines the determinants of health o that need to be addressed through upstream, midstream and downstream interventions and measures to see if the interventions are effective

Answer 1

Healthcare coverage for all

I will use Census data to analyze it. Analysis will be done on population in a particular geographical area, age group, number of dependents, local state weather conditions (if it is industrial area, number of services covered under health insurance will be more), Definitely, there will be NO one size fit for all. Data has to be analyzed in multiple directions so that I can make possibly most best decision

Upon analyzing the data, pricing of plans will be decided with customized options for people and this will be done based on state to state or area to area where applicable.

Improved quality of care

  For this, I will leverage IT and get members, providers, insurers online. This system will be having options such as member past claim history, treatments, and the solution. By this way, providers work will become easy to assist the patient. For member, they don't have to remember everything. One click will get their information for the provider pursue. This system will also saves time for both member and provider and provides and saves financial information.

Value based Care

Providers will be paid for the services they deliver. This will help in customizing the provider services. If the member is ready to pay more for his/her insurance policy, he will be provided more services. For example, a 20 years person may not need dental services but a 50 years old person might need it at regular intervals.

Improved access

I will propose a plan to setup a clinic/hospital based on population in a particular geographical area. Example a primary care physician for every 1000 and a major hospital for every town with 10000 population. (numbers are assumptions)

Lower Cost (Affordability)

Costs in health care is so complicated as they works in round robin fashion. To reduce the policy pricing, providers have to reduce their charges. But if the Govt has to reduce the price of insurance to get everyone insured, I will propose a system for providers which gives them a standard amount irrespective of number of services they provided. Consider it as a Salary. So that they can earn some money for living. Alternatively it will encourage to provide services at competitive prices which let the Govt to negotiate the pricing. Based on it, Govt will decide the insurance pricing for individuals.

Improved Patient Satisfaction

As discussed earlier, more number of hospitals will be brought into network so that people will have access to more service providers. Also with the competitive pricing, members will be getting more number of services with less amount which improvises the satisfaction. Apart from that, all providers will be given basic training at regular intervals to make sure they are provide services only when needed (not unnecessary services which leads to waste/fraud)

Improved Provider Satisfaction

All providers in the network will be given some amount for being in the network. This will help in, letting them continue to be in the network and make some money. Apart from that, a rating system will be introduced to get feedback from members and highest rated providers will be given some monetary benefits in addition to their monthly fee. Not just money but also these ratings would make them as preferred service provider.

   Implementation of population health model

This model helps in determining/understanding the overall health statistics such as life expectancy, social habits, current deceases/health issues (example: number of diabetic patients in city "A"). To implement this the Government has to collect the data from providers and all other relevant departments such as census, birth and death register etc.

Funding can be provided by 1. either taxing a small amount say 25cents on every $100 spent by public. or by taxing the rich more and poor less.Few other alternatives is making the insurance a mandatory for all residents in the Desiland and an offence (with hefty fines) if not insured.