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The health care system as we know it could experience significant difficulties over the next few months, says Brian Klepper, PhD, president of Healthcare Performance Inc. in Jacksonville, FL.
He cites rising health care premiums and a flagging economy as reasons the health care industry is in trouble. But the system can be fixed, and case managers are likely to have a big role in the solution, Klepper says.
Those assertions are backed up by a group of reinsurers, providers, and HMO representatives who came up with seven principals for how to fix the system, and case managers are likely to have a big role in the solution, Klepper says.
Among the issues they called for were uniform adoption of best practices and public availability of performance information.
"We need to find ways to eliminate variabilities in the system, through traffic controllers who are essentially case managers. The only way it can be done is if the case managers have guidelines to follow and the authority and buy-in they need," he says.
A major cause for problems within the health system is soaring health insurance premiums that have gone up double the rate of inflation for the past four years, he says.
"This year, the premium increase that has been leveled on employers is four times inflation, about 18% to 20% for large businesses and 30% to 50% for small business," Klepper says.
Rising premiums were no problem when the economy was prospering, but now that the economy is in a recession, business leaders are saying they will significantly increase employees’ share of the cost, Klepper says, predicting a dramatic increase in the number of uninsured, beginning this month. "Nobody who makes $35,000 a year can afford to pay $7,000 a year for family coverage," he adds.
He predicts a big increase in the number of emergency room visits, and a spike in the inpatient days in the public hospitals as private hospitals stabilize patients and send them to public hospitals.
"Since 40% of American hospitals are already running in the red, if you get a spike in inpatient costs and a reimbursement vacuum, they are going to start to go under," he says.
Klepper has operated a health care consulting practice offering operational audits and business development services. This has given him a bird’s-eye view of the system, he says.
"As a result of the way health care has grown up, it’s become Wyatt Earp land. Everybody is out there for himself. Everybody is trying to make money. Everybody is less interested in the system than they are in their specific benefits from the system. That’s why the system is getting ready to fail," he says.
The tremendous variation among providers in the quality of care and lack of accountability among providers, insurers, and patients has put the system in jeopardy, he says.
"If we keep the existing system, there have to be new disciplines that everybody buys into — all stakeholders, including consumers. We must say that we are all going to use the standards and be responsible for the choices we make," Klepper says.