There is no doubt that this country needs to find a way to take inefficiencies out of the healthcare system.  But, looking to how other countries have done it, while a useful education, should not suggest that we model our system off of others that do not offer the level of innovative and quality care that most Americans enjoy today.  Similarly, it should not mean denying access to care for those who don’t have it today — or limiting options for those who do have health coverage. 

Clearly, there are big complex issues that need to be sorted out…these range from how to take the inefficiences out of children’s health insurance, medicare and medicaid in a way that maintains access to care but minimizes fraud and waste, to how to help innovative businesses continue to have protection on their innovations such that they can fund research and even fund a greater level of access to free medications and procedures than they do today.  Complex issues..absolutely.  But, in the need to address the complexity, we seem to have forgotten some basics that will save costs and improve care.  Following are 10 things for the experts to consider when reshaping what healthcare will look like in America:

1.  Incentivize health professionals, employers, insurers and individuals to focus on wellness.  Taking the steps to prevent serious disease will pay huge dividends in the future.  Smoking cessation, weight reduction, avoidance of asthma triggers, stress management…all of these preventative approaches slow the use of healthcare services and delay the acute events that drive traffic to emergency rooms and result in costly procedures.

2.  Fund “well” clinics and encourage routine check-ups including basic testing — incorporate nutrition and prevention into the discussion and mandate (and incent for) routine visits.

3.  When you knew ytou family physician and trusted his or her advice, you were more likely to skip the extra ice cream cone (you might run into them at the ice cream parlor).  Relationships with healthcare providers are critical and ensure better compliance with wellness programs.  We must enable people to build relationships with community healthcare providers.   Not just physicians.   If you know the nurse practitioner or physician’s assistant at your local wellness center, you will use that facility vs. the emergency room when flu symptoms strike or allergies are out of control. 

4.  Reward compliance with medications.  Asthma well-managed on a day-to-day basis reduces use of ER services for acute attacks.  Consistent use of prescribed cholesterol-lowering medications not only reduces risk of a heart attack but also may have beneficial effects beyond heart disease.  Consider medications for chronic health conditions to be a preventative action and incent proper behaviors for prescribing as well as taking medications proven to prevent serious complications.

5.  Reimburse allied health professionals and make them the front lines of care.  Nurse practitioners, physician assistants, certified diabetes educators, pharmacists…all can play critical roles in front line medicine — particularly in doing what it takes to keep people well.  Empower them…and importantly, pay them.  Studies have shown that diabetes clinics that employ regular use of certified diabetes educators are more likely to have a patient population with A1C levels in accordance with treatment guidelines.  But, there is a shortage of certified diabetes educators because there’s little incentive to take on this role plus, many diabetes clinics are not adequately reimbursed for their involvement.  Imagine the cost-savings of having people committed to helping a person with diabetes stay in control…reduced use of endocrinologist time, less medication and fewer hospitalizations not to mention the reduction in devastating complications of diabetes from cardiovascular disease to blindness to amputation.

6.  Work with insurers and private entities to get Americans to invest in their own health.  Encourage programs that enable Americans to invest dollars toward their goal of losing weight or stopping tobacco use…and then double or triple their investment when they succeed.  It’s a win-win.

7.  Partner with and reward employers that take care of employee health. 

8.  Healthcare is community-driven.  Work with municipalities to identify the resources, networks, support systems and leaders in their communitie to set up initiatives that will help its citizens to be healthy.  Set up systems to measure success and reward that success.  Whether it’s funding for community education, eldercare or the environment in their city, when a municipality does the right things to improve health while reducing care, other services should benefit.

9.  Foster innovation.  We are fortunate that we live in a world where medical innovation has turned acute and deadly diseases into chronic conditions.  That is part of our cost issue…we live longer.  But, the more we foster innovation, the more likely we are to make less expensive, more effective forms of life-saving technology.  Think of that first computer — bulky, unwieldy, expensive — further innovation led to efficiency, mass availability and even reduced costs.  We need to encourage the same in healthcare.  Innovation for the cure is important.  Innovation for efficiency and mass availability is even more important.

10.  Remember the CARE in healthcare.  Make decisions because they will help people stay well…not just because they will cut costs.