Missouri Healthcare Discussion

Last month, there was an article in the St. Louis Business Journal where several industry leaders commented on the future of healthcare for Missourians.  I thought several of the comments were universally relevant.

The participants were:

Facts / Comments from the article:

  • If you are living under 300% of the FPL (federal poverty level) and don’t have insurance, you are twice as likely to be admitted to the hospital for an avoidable condition
  • Government is the biggest payor – 10M lives covered as an employer, 40M Medicare lives, 51M Medicaid lives, and 47M uninsured.

“The tragedy in St. Louis right now is that within the city and parts of the county, we still have third world outcomes.”  [Ron Levy]

  •  70-80% of everything the doctor says isn’t understood by the patient
  • Dr. Lipstein mentioned a few of the BJC websites for the public – helpforyourhealth.org and myhealthfolders.com.  I scanned the helpforyourhealth site which has some nice features like a ask the pharmacist button where the Q&A is posted for everyone to see.  On the other hand, the myhealthfolders appears to be their own PHR but mostly self-reported information.
  • Dr. Lipstein also talks about the fact that they have evidence that investing in health literacy and promotion, screenings for blood sugar, cholesterol, blood pressure, and BMI, and getting people into programs to manage diseases or risks can lower the costs of healthcare.
  • Dr. Lipstein also says that the Cleveland Clinic won’t hire anyone who smokes anymore and Scott’s gives you six months to quit smoking or you get fired.  (Based on the fact that it costs about $3,400 more per year to employ someone who smokes.)
  • They talk a little about the Danish model of healthcare where primary care physicians are actually paid more than specialists.
  • Dr. Peck talks about the fact that 75% of healthcare costs are from people with chronic disease and many of those could be identified early through risk factors.
  • Ron Levy talks about how 1/3 of the Medicare costs are spent in the last 3-6 months of life.

It was a good piece.  Healthcare as always is complicated with lots of factors.  The only way to fix things is to understand the correlations, isolate a few factors, and improve them.  I think a lot of solutions get discounted because their is always some reason why they can fail.

My big takeaway from the discussion was prevention.  We need more education, more screenings, and more wellness activities.  The question is aligning incentives at the patient and payor level to invest in these.

3 Responses to “Missouri Healthcare Discussion”

  1. who said this?

    “70-80% of everything the doctor says isn’t understood by the patient”

    Do you have a citation or source at all please?

  2. The fact that doctors are not understood by most patients is the doctor’s fault–all the way. I took my 16 year old daughter in for a nasty cold sore on her lip. The doctor said something like “You have a severe edema. It is more likely viral than bacteriologic and best treated with a simple analgesic.” Of course my daughter’s eyes glazed over at “edema”. I thought this doctor must not be secure with his intelligence. All he had to say was, “You have a swollen lip. It will probably go away on its own in a few days. Just put some cream on it so it won’t hurt as much.”

    On the issue of better disease management and education, the recent report by Rand does not support this.

    The solution you propose–more education, more screenings, and more wellness activities–is not the answer. We need to understand what solution we’re throwing at who and why in order to make a real difference. That, unfortunately, will not come from a focus on disease and risk factors. I know that sounds counter-intuitive, but it is the truth.


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