U.S. healthcare needs team-approach, patient focus

The U.S. healthcare system, broken even before the Affordable Care Act, needs a team-based care approach that’s more focused on patients, as well as an increased political effort to advance healthcare, according to researchers speaking at a JAMA media briefing at the National Press Club in Washington, D.C., on November 12.

A group of researchers presented articles on “Critical Issues in Healthcare” that were published in the November 13 issue of JAMA

The healthcare system is not working because patients feel powerless, said Hamilton Moses III, MD, of the Johns Hopkins School of Medicine and the Alerion Institute. Since 1980, the share of private insurers has remained relatively constant and government share of insurance has risen from 33% in 1980 to 44% in 2011. “As a consequence, the individual has been marginalized,” Moses said.

Patients have also been marginalized by lack of competition in the pharmacy marketplace, according to Moses. Four pharmacy chains hold a majority of the market share, “which means limited choice for consumers.” Approximately 75% of physicians are employed by healthcare systems and hospitals – instead of being independent – which Moses said contributes to an unfair system for patients. “In the years to come, patients have to have a voice. If the patient is ignored too long, it will minimize the progress we can make,” he said.

The U.S. healthcare system needs a new, audacious goal: limit healthcare expenditure growth to the growth of the national economy, according to Ezekiel J. Emanuel, MD, PhD, of The Perelman School of Medicine and the Wharton School, University of Pennsylvania. “That is, by the end of the decade, healthcare costs per person will not grow faster than the economy as a whole,” Emanuel wrote in the JAMA editorial.

To help alleviate some of the out-of-control healthcare spending, the system needs to focus more on team-based care, Emanuel said. “It will require substantially more focus on delivering care to the 10% of patients with chronic illness. It will require turning care delivery upside-down. Instead of focusing on care in the hospital, more outpatient monitoring of these patients, and more interventions at home are necessary to keep them healthy and with fewer emergency department visits and hospitalizations,” Emanuel said.

“To achieve this requires electronic records with real-time tracking of leading physiologic indicators. It requires team-based care coordination between office, hospital, pharmacy, and home. It requires reducing the use of inappropriate interventions. If all this happens, then the other goal that everyone believes is critical-improved quality of care-will be achieved,” he added.

Politically, the U.S. needs to focus more on advancing healthcare and less on the politics of the Affordable Care Act, Joshua Sharfstein, MD, of the Department of Health and Mental Hygiene in Baltimore, Md., and JAMA editors wrote.

“The Centers for Medicare & Medicaid Services is promoting accountable care and other innovations through the Medicare and Medicaid programs. However, broad changes are not on the horizon, and Congress is distracted by efforts to undo the Affordable Care Act. Ironically, addressing the increasing costs of healthcare would reduce the pressure on the federal budget and make political conflicts in Washington easier to resolve,” Sharfstein wrote.