The U.S. healthcare system is undergoing a dramatic transition as the industry strives to achieve the goals of the Affordable Care Act (ACA) to improve an inefficient, unsustainable system. Physicians, insurers, pharmacists and other players in the patient care arena are shifting roles and forming more collaborative, coordinated networks to fill the gaps in care and reduce practice redundancies.
What are the key changes in this new healthcare scenario? In part one of a seven part series dedicated to the emerging role of the pharmacist in the healthcare ecosystem, the topic of what is ailing the U.S. healthcare system is discussed.
While healthcare in the U.S. is considered among the highest in quality, it is also among the most costly with significant gaps in care and inefficiencies. Currently payments are based on volume, not value or outcomes, and employers and taxpayers are not happy with the return on their investment.
The 2011 National Scorecard on U.S. Health System Performance1 found that care coordination is rare and almost half of Americans reported communication problems with their primary care physician. There has been substantial erosion in access to high- quality, efficiently delivered care, contributing to rising health care costs.1
Based on the scorecard’s 42 indicators of health system performance, the U.S. scored 64 out of a possible 100 when comparing national averages with benchmarks of best performance achieved internationally.
Performance on indicators of health system efficiency remains especially low, with the U.S. scoring 53 out of 100 on measures that gauge the level of inappropriate, wasteful or fragmented care; avoidable hospitalization; variation in quality and costs; administrative costs; and use of information technology.
In the 2008 rating, only 43% of adults with health problems could rapidly get an appointment when they were sick, 19% of U.S. patients reported undergoing duplicate tests, and only half received all recommended screening and preventive care. Further, the U.S. failed to keep pace with gains in health outcomes achieved by the leading countries. Among 16 developed countries, the U.S. ranked last on a measure of mortality that could have been avoided with appropriate medical care.1
A 2013 survey found that 37% of U.S. adults went without recommended care, did not see a doctor when they were sick, or failed to fill prescriptions because of costs, compared to 4-6% in the U.K. and Sweden.2 In a comparison of 12 industrialized countries, healthcare spending in the U.S. in 2008 reached $7,538 per capita— far more than any other country studied and more than double the Organization for Economic Cooperation and Development (OECD) median of $2,995. Hospital spending per discharge far exceeded all other countries at $16,708—nearly triple the OECD median of $5,949.3
In the long-standing traditional model of healthcare, providers and payers still act in silos, without communicating with the patient and to each other about the patient. A patient interfaces with a primary care doctor, then a specialist, a pharmacist, hospital and an insurer, but patient information following each contact is usually not shared among the patient’s medical team. This lack of coordination leads to duplicate processes and care, such as the patient filling out separate forms for each care team player or taking duplicate tests.
While abundant data is available, it is not actionable. The challenges are: Who should get the data? What data points do they need? Is there infrastructure in place to distribute it? What happens when others receive it?
Part two of this series will discuss the Challenges of Healthcare Reform.
- Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011. The Commonwealth Fund Commission on a High Performance Health System. Accessed at: http://www.commonwealthfund.org/Publications/Fund-Reports/2011/Oct/Why-Not-the- Best-2011.aspx?page=all.
- New 11-Country Health Care Survey: U.S. Adults Spend Most. The Commonwealth Fund. Nov. 13, 2013. Accessed at: http://www.commonwealthfund.org/News/News-Releases/2013/Nov/New- 11-Country-Health-Care-Survey.aspx.
- Squires D. The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations. July 2011. Accessed at: http://www.commonwealthfund.org/~/media/Files/Publications/ Issue%20Brief/2011/Jul/1532_Squires_US_hlt_sys_comparison_12_nations_intl_brief_v2.pdf