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The future of health care: the intersection of lowering cost and improving quality

December 23, 2016
Satrajit Misra
From the December 2016 issue of HealthCare Business News magazine
How do we make lowering cost and improving quality care for patients a reality? It’s the question every health care institution is trying to answer. The Affordable Care Act (ACA) has unfolded significant changes to the industry since its inception. Health care providers must lower costs and improve quality care for the population. It’s the “cost/quality paradox” and there is no easy answer.

The upside of the ACA is it has done well for our society. It helped about 20 million uninsured people acquire insurance, giving them access to health care they need and deserve. But this comes with many challenges, most critically, putting a huge cost burden on individuals. While more people enter the health care system, insurers are unable to leverage the healthy patients to balance out the more expensive sick patients. Now insurers are looking to significantly increase premiums next year, making care less affordable.

Diagnostic imaging can play a big role in improving patient care while reducing costs. The right technology, fully integrated into a provider’s practice with the right training and education, can help diagnose diseases earlier and more accurately. It can also help facilitate less invasive procedures, reduce recovery times and provide accurate follow-up care.

One major shift we’ve seen as a result of the ACA is that hospitals are consolidating into larger, independent delivery networks (IDNs) to reach more patients and share best practices. However, consolidating hospitals often initially increases costs, while C-level executives integrate multiple and diverse PACS, diagnostic imaging equipment, staff, workflow and protocols.

Another result of the ACA is the evolution of provider-led health plans. These organizations, like Kaiser, combine a nonprofit insurance plan with their own hospitals and affiliated facilities. Kaiser has invested billions in electronic health records and new technology, including medical imaging across all of its facilities, big or small. This has led to better coordinated care. While their health plan is paid as a fixed amount per member, Kaiser must keep patients healthy and out of the hospital to reduce cost. It’s a business model that meets three pillars necessary to solve the cost/quality paradox.

• Access: Advanced technology must be spread across an entire health system. If patients can’t receive the care they need at a facility near them, then that’s not accessible.

• Affordability: Solve access problems, but also bring the cost of solutions and services down across all providers.

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