Community Insurance for the People

We are all probably aware of the Medicaid expansion that is occurring across the country. There is also a simultaneous expansion occurring among private insurers and employers. So goes Medicaid, so goes the rest of the insurers. The changes brought about by the American Recovery and Reinvestment act and the Patient Protection and Affordability Care Act seemed to have moved this country in another direction. This not only affects health it also will impact workforce development and economics. For better or worse, things are certainly changing.

Insurance companies are expanding their Accountable Care Organization (ACO) networks in a fast paced move to change the way physicians and other providers are paid. As these insurers move more into the Medicaid market with Health Insurance Exchanges and other products they have an opportunity to change our broken health care system to a more financially successful entity with better clinical outcomes. I remember when “health reform” first began and I didn’t know how the major insurers would be impacted. Now I realize that the resiliency of the insurance industry is phenomenal. Therefore, I am assured that there will be enough insurance in place to go around for everyone (if they can afford it).

Patients will have better opportunities to optimize their care as they become more involved in the day to day management of their own health. Self-management, including lifestyle management, is a key component to the patient’s health and well-being. As we improve patient engagement opportunities that hinge on models like the Patient Centered Medical Home (PCMH) and ACO, we bring a more comprehensive approach to the US health system with an opportunity for better patient outcomes. I continue to use the word ‘opportunity” because it only works if the people are engaged. We can build the best bicycle built for man, but it is of no use if someone doesn’t drive it. Health and health care is all focused on people and not just the patient. The people include the patient’s family, nurses, lab techs, doctors and all other stakeholders that will have a handle on some part of the machine.

People power is real. People make the policies and people build the systems that create the environment for a healthy population. Therefore, air pollution is just as much a part of this as is the pill that we swallow for an ailment. Some determinants of health are much more difficult to affect than others but these factors contribute significantly to the underlying cause of health outcomes and can’t be fully accounted for through good clinical measures or paid for by receipt of the clinic bill.

This is not about insurance reform. This is about the people. Maybe it’s not a reform at all. We probably should call it a “new day” in health care. This is the day when we use compassion and the best of our knowledge to improve the health of every individual in the US. We aim to improve population health but also understand that it is an individual that walks into a clinic or hospital practice. Maybe the patient will be my son or your daughter who we would want to receive the best care whether they were the most successful child or a juvenile delinquent.

Health care is a local thing and who best takes care of the locals? The people in their community are their best care takers. With the fact that insurance companies have such an influence over how care is provided in this nation, it is important that they help set guidelines that assure that community practices and hospitals are in place to take care of their neighbors. They should make sure that smaller practices and hospitals survive. The health of the community is not just connected to mental or physical health it is connected to economic health as well. Communities need more than employers. They need employers who are from that community and understand that community. You have heard the story about how kids grow up and leave small communities to experience life in the bigger and better world. Well it’s time for the world to give back to these communities that have less and need so much more. Their survival and wellbeing affect all of us much more than we know or are willing to admit. That’s called community Insurance for the people.

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