We are seeking a healthcare fix that will rise beyond the rhetoric. We are focused on the identification and agreement on the fundamental problems that are affecting our ability to find effective solutions. From the identification and agreement on the problems we offer pragmatic solutions. We are targeting that at least 70 percent of the proposed solutions find bipartisan and bicameral support.
While it has become almost hopelessly lost in the rhetoric of politics, we have had almost universal agreement on the basic goals for our healthcare system for many years. In meetings with both republicans, and democrats whether they lean conservative or progressive they tend to agree on the following goals:
- Available & Accessible Coverage for All (100 percent of Americans)
- Affordable Coverage for Americans
- Affordable Coverage for America
- Minimum Standard of Care
- Affordable Coverage Regardless of Pre-Existing Condition
- Affordable Coverage Regardless of Disease State
- Reduction of Overall U.S. Cost of Care
- Reduction of the Individual Cost of Care
- Ensure Coverage for the Underserved
- Provide an Effective Safety Net
In everything we endeavor to bring forward as a solution we believe it is imperative that we provide for each of these stated goals and that we deliver the solutions with the full intent and meaning of the goal.
While the basic Goals provide an overarching basis for measuring the success of our efforts at delivery of a effective solutions, we also have identified a number of additional systemic objectives that we think must be ingrained in any resulting healthcare system. We are developing our set of solutions to address the historical and current problems and to provide the simplest and most effective system to achieve the following additional objectives:
- Deliver on the promise of available, affordable, effective and easily accessible care covering basic health needs for all (100 percent of Americans) – LifeCare Plans
- Provide integrated choice driven, available, effective and accessible care covering the additional services that Americans want – Quality of Life Care Advantage plans
- Assure a cost effective, fair, and easily accessible Safety Net for all Americans
- A solution that converts “Patients” from inactive recipients of ineffective health services, to active Participants in the selection, management, delivery and prevention of care.
- Assures price certainty, cost transparency, and full care portability
- Require No Deductibles, no Co-Pays, no hidden fees – all cost easily defined, certain and accountable
- Provide full cost disclosure for all parts of healthcare, no hidden reimbursement systems, no rebates and no self-propagating cycles that obscure full and true cost
- Assure coverage regardless of pre-existing condition or disease state
- Deliver a system with checks and balances that select for reduction of overall U.S. cost of care as well as reduction of the individual’s cost of care
- Allow no government “Death Panels” instead provides a representative citizen group of participants, facilitators, providers and sponsors that are empaneled to determine what constitutes basic health needs, treatments and therapies and establishes effective payment rates for providers under basic LifeCare Plans
- Assure appropriate, effective, and efficient delivery of basic health needs
- Effectively balance care outcomes expectations to healthcare’s ability to deliver effective services.
- Deliver the ability to seek the provider(s) of their choice
- Transform employers from the provider and manager of healthcare through Employer Sponsored Insurance to focus on wellness and prevention and act as a facilitator to help employees both afford basic health needs, LifeCare plans and effectively plan and save for Quality of Life Advantage services.
- Improve Participant outcomes
- Integrate any market based solutions by providing a single system of resources for Participants, Facilitators, Providers and Sponsors to fully effectively coordinate all care and benefits needed by Participants across all available sources. This system should:
- Provide Participants
- a central place to identify and register their care needs
- automatically apply for all benefits with a single dynamic entry system
- source, review, compare and select Facilitators and Providers
- manage access to their information and provider network
- provide access through a true Participant centered system between all Facilitators, Providers and Sponsors with adequate security, information needs and access controls
- Match all needs to all appropriate and available resources in a least cost tiered method approach
- Assure checks and balances to inform, enforce and secure privacy controlled interactions among their virtual care team.
- Provide Participants
- Provide Facilitators
- An effective and low cost system to assist Participants in sourcing, applying and accessing all needed resources.
- A mechanism to appropriately identify appropriate payment resources by matching the participants needs to Sponsors registered program eligibility criteria
- A systemic mechanism to identify potential Provider and Sponsor conflicts and areas of potential duplication of services and benefits
- Mechanisms to help identify and report fraud
- Provide Providers
- An effective and low cost system to appropriately match their services to Participants needs
- A mechanism to assist in establishing fair, effective and competitive pricing.
- Improved ability to manage patient mix and reallocation of services to other Providers
- An efficient and effective way to identify, qualify and integrate their services with additional Sponsors to expand the opportunity for payment.
- Provide Sponsors
- Effective and low cost system to identify and integrate Providers with the Sponsor’s program Participants via a much simpler and drastically lower cost model.
- A fair and effective system to eliminate duplication of payments due to the unknowing duplication of services by Providers
- An effective mechanism to identify and reduce or eliminate duplicated payments due to fraud and abuse
- An effective mechanism to manage the provision of multiple services by multiple providers through multiple programs with effective balancing of roles responsibilities and cost
- Allow for new ways to spread cost of services via;
- Balancing of payments across all eligible programs
- Payer of last resort systems
- Negotiated share of cost settlement
- Innate validation of most co-morbidities across Provider sources
- Eliminate the Silo Effect
As we move through each of the fundamental problems in our historical and current system we will make sure that we incorporate these systemic goals into what becomes our final integrated set of solutions.