The quality of care for older individual, who frequently have complex medical issues, can be considerably impacted by healthcare delivery paradigms. Effective primary care delivery may be hampered by the old fee-for-service (FFS) approach, in which clinicians are compensated for billable services regardless of outcomes.
In “The Coming Primary Care Revolution,” a study from Harvard Medical School, four ideal healthcare model guiding principles are presented:
- Value-based compensation
- Connections as the cornerstone of care
- General practitioners treating complicated diseases
- Emphasis on providing holistic care.
Seniors need a healthcare system that offers comprehensive, ongoing care, and while the ideal system may seem unreachable, millions of older Americans are already served by existing resources. Therefore, it is entirely possible to achieve this. However, it’s critical to examine current senior care models in the US and how they compare to this ideal model in order to comprehend this further.
The Medicare Principle and the Old Senior Care Model
About 63 million US persons over 65 use Original Medicare or Medicare Advantage, making Medicare play a significant role in the care of seniors. Although it has restrictions, original Medicare provides hospital, outpatient, and medication coverage.
However, seniors who can’t pay for a Medigap Supplement could incur large out-of-pocket expenses, which could cause them to postpone treatment, cancel appointments, and forego preventative services.
Additionally, Original Medicare frequently does not pay for non-visit services like transportation, making it more difficult for senior citizens who have mobility concerns to go to appointments.
The Advantage of the Medicare Model
Medicare Advantage (MA), a commercial health plan option chosen by roughly half of all Medicare recipients, uses Medicare funds to offer insurance to qualified adults. These plans frequently include hearing, vision, and dental coverage, and typically bundle Medicare Parts A, B, and frequently D at prices comparable to or cheaper than Original Medicare.
The “full-risk” or “full-capitation” model, on the other hand, means that the insurance provider offers the Medicare Advantage funds to the medical provider as a fixed monthly fee for every patient.
The medical provider will offer guaranteed care for the patient’s encompassing healthcare needs. This includes primary care, hospital services, speciality visits, and pharmaceutical needs.
How the Future of Senior Care Looks Like
This full-risk model relies on the four principles mentioned above:
- Value-based compensation
In essence, the health provider would receive fixed payments per month for every patient they have in their care. Any funds that they don’t spend toward the patient will go into their own pockets. Moreover, the PCP will be incentivized to keep the patient healthy at all times so as to avoid costly medical procedures and hospitalizations. The emphasis is then on the value of primary care, no its volume.
- Connections as the cornerstone of care
With this new model that isn’t based on volume, PCPs can limit the number of patients they care for. This gives them significantly more face time with every individual patient, which will foster a deeper inter-personal relationship between doctor and patient.
The doctor will gain the patient’s trust easier and they will be able to provide unique assistance that would otherwise be almost impossible to provide.
- General practitioners treating complicated diseases
The full-risk model lets the primary care provider collaborate seamlessly with specialist colleagues and send the patient to any facility that can offer diagnostics and treatments for high-complexity conditions.
This is a much better alternative than what is currently available because the PCP is the only one fully aware of the patient’s full physical and emotional health. They can make the best medical decisions for the patient.
- Emphasis on providing holistic care.
Thanks to the full-risk model, PCPs will be able to focus on a patient’s entire health profile, including hearing, vision, dental care, mental, emotional and spiritual health, and health behaviors.
The full-risk model is a more comprehensive and helpful senior care model than what we have now. It allows us to transform the lives of senior citizens in the US by offering them true medical care that makes a real difference.
Call Primary Medical Care Center at (305) 751-1500 for more information!