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ODs will play role in changing US health care delivery
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SAN ANTONIO – While he believes there is, “something terribly wrong with our health care system,” Ezekiel J. Emanuel, MD, PhD, vice provost for global initiatives at the University of Pennsylvania, said, “I’m widely optimistic about the future of health care in the U.S.”
Emanuel addressed attendees here at the American Academy of Optometry meeting during the plenary session on the future of health care delivery, which Primary Care Optometry News cosponsored.
Emanuel showed a graph indicating life expectancy in relation to health care spending in various countries between 1970 and 2014.
“We spent a lot of money and we did not get an increase in life expectancy,” he said. “Greece and Spain are doing better than the U.S. We need to do better.
“What’s the difference between us, France, Germany and all the other countries?” Emanuel asked. “It’s not that they have advanced technology. It’s not that they have drugs that we can’t use here. It’s all about how we deliver care. We’re doing a very bad job at how we deliver care.”
He said one problem is unnecessary services and inefficient care. Expensive technology is being used for conditions where there is no proof that it is beneficial, Emanuel said.
However, “when the U.S. focuses on something, we can be the best in the world,” he continued. “We are the most innovative, entrepreneurial people in the world.”
Emanuel said the future trends of high-value care are:
- Private sector-driven changes;
- Shift towards value-based payment;
- VIP care for chronic conditions;
- Greater use of nonphysician providers;
- Deinstitutionalization of care;
- Performance measurement of physicians and other providers;
- Incorporation of behavior health in regular care; and
- Excessively high drug prices.
Emanuel said we will see bundled payments to specialists, where instead of services and supplies being paid for individually, we pay one price for a unit of services. For example, with a hip replacement, the patient pays one bundled fee, not individually for the hospital, the specialist and other typical charges.
A shift of post-acute care to the home will contribute to savings, he said.
Primary care physicians will see more capitation, where they are paid per-patient instead of per-service, with the incentive to keep that patient well.
We will also see changes in the site and structure of service delivery, Emanuel said.
“We are moving closer to the patient,” he said. "Examples are Walmart’s Care Clinics and the merger of CVS and Aetna."
“CVS and Aetna claim that this will lead to more integrated care, better adherence to a prescribed regimen and lower cost of care,” Emanuel added.
There are already 1,100 CVS MinuteClinics in the U.S., he said.
“The site of care may change for lab tests, check-ups and immunizations,” Emanuel said. “These changes will hugely impact nonphysician professions.”
He noted the shift that has already occurred – with nurse practitioners and physician assistants managing low acute conditions.
He said America’s optometrists will continue to see their responsibilities and privileges expand.
“You don’t need an ophthalmologist,” for glaucoma treatment, Emanuel said.
We may see more optometrists conducting laser surgery and administering injections, he said.
– by Nancy Hemphill, ELS, FAAO
Reference:
Emanuel E. The future of health care delivery. Presented at: American Academy of Optometry meeting; San Antonio; November 6-10, 2018.
Disclosure: Emanuel is chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania.