For the second time in 2 years, the Supreme Court of the United States has defended the Affordable Care Act. It’s time to move on. The ACA was designed, in part, to help transition the United States healthcare system into a value-based system. Another purpose of the act and now a side benefit is that around 15 million Americans have gained insurance where they previously had none.
Politics aside, the Affordable Care Act is designed to be an affirmative step to change healthcare in the United States. Yes, it probably has flaws. Yes, it probably rankles some policy makers and members of Congress. But it’s a movement in a direction in which this country needs to go. We NEED to change healthcare in this country; we can no longer afford to let healthcare go the way of the wild, wild West. If we don’t change, Medicare may go broke and that will be the definitive end of political bickering for sure.
The “icon” of change that is embedded in the ACA is the Annual Wellness Visit (AWV). It’s a small, minor part of the 1,000 page act itself. But the AWV is a metaphor for the change that could and should come about within the entire healthcare system that is focused on “early detection.”
Why is “early detection” so important to the concept of value-based healthcare?
Simple. If you have a system in place that predicts risk of chronic illness and falls and properly alerts the right care teams, then those care teams have a better than average chance of intervening proactively in the health of the patient and preventing costly chronic illness.
Let’s break it down with a simple example:
Marge, our fictitious patient, has high blood pressure. Her doctor knows this and sees Marge 4 times a year to monitor the B/P and make sure she’s on the right medication to control that problem. Marge dutifully goes to her doctor for these appointments. Everything is rosy, right?
Wrong. Marge also is losing muscle strength but hasn’t told her doctor about this problem because there’s not much time to discuss her other health issues when she meets with her doctor for her 15-minute B/P visit. When she climbs the stairs at home, her legs are tingling and numb (neuropathy). She finds that she gets SOB when she plays with her grand kids. Also, her short term memory is showing signs of degradation. Marge is also having issues reading the newspaper now because there’s a “blind spot” in the middle of the paper that is beginning to show up. And now, Marge is staying home more than normal because she’d depressed about all these issues.
Marge did agree to come in for her “Annual Wellness Visit” – a new program she just found about. During this 30 minute visit, her risk factors were identified for a number of chronic issues and a comprehensive report was generated that went to her doctor.
The AWV report shows that Marge is at risk of falling. She is a candidate for physical therapy that would help her with not only her loss of muscle strength, but could reverse the effects of depression as well because she would be out with people once again and chatting like she used to do. Her increase in exercise may have an effect on her SOB as well. Likely this will reverse the neuropathy in her legs as well, and stabilize her walking.
Marge is also a candidate for a referral to an ophthalmologist who treats patients with a new drug that can help reverse the early effects of macular degeneration. This rapid response may, in fact, slow the progression of her deteriorating eyesight.
Regarding Marge’s memory loss, a referral to a neurologist may allow Marge to participate in some new clinical trials with new drugs that can stabilize the formation of plaques in the brain – thus possibly slowing or stopping the progression of mild cognitive impairment. The neurologist may also recommend memory exercises for Marge to force her to increase the activity of her brain.
But wait, you ask. These extra “visits” and “treatments” are costing a lot of money. Surely, CMS does not approve of these expenditures when in fact it’s trying to SAVE money within the healthcare system?
Actually, CMS actually WANTS physicians to take these proactive actions for their patients. Yes, they will incur some expense to the system. But compare that minor cost to the money that will be saved by Marge NOT falling and breaking her hip: Ambulance, Emergency Room, Pre-Op, Orthopedic Surgery, Post-Op, Hospital stay, Subacute care, Rehab, etc. Add that to the money saved by containing Marge’s depression and her macular degeneration. The savings are substantial to our healthcare system.
Now multiply Marge’s savings times about 10 or 20 million. Wow, now we’re talking about a major revolution in healthcare in the United States. That is the potential effect of the Annual Wellness Visit on the spend rate of CMS. It’s a game-changer.
So we applaud SCOTUS for its decision for one simple reason: The Annual Wellness Visit continues to work to contain cost by proactively identifying problems that can be prevented before they manifest themselves into expensive chronic issues. Politics aside, we’re grateful to SCOTUS for their decision. We think Medicare just got a new lease on life because of their decision.