The Great Mystery

            I work in healthcare IT for prestigious, large, healthcare organizations and have been at this for about 20 years now. Business is booming thanks to implementation of electronic medical record. My work involves understanding the world of healthcare benefits offered by insurance companies, government agencies, and employers, from clinical and care delivery, through revenue and financials. I dabble in the patient access side of the house, but live in the revenue management house, so I often hear the words, “No money, no mission.” Meaning, if there is no money for hospitals and doctors, they can’t carry out their mission of patient access to quality medical care. Healthcare reform is a huge focus these days. I often refer to how patient’s, specifically the elderly ones, elect healthcare benefits when choosing a Medicare HMO as “the Mystery”. I refer to the conundrum on how to fix America’s healthcare dilemma and provide quality medical care, efficiently, and make it affordable to the masses as, “The Great Mystery.” There are no easy answers to this quagmire.

                 Positive changes have already come of some of the healthcare initiatives. With wider coverage and better benefits, particularly around preventive medicine, I see a trend moving away from “cash only clinics” to billing insurance companies for services that were not previously covered. Birth control is an example of such a service. I also see this for things like travel medicine where people going overseas need vaccines, and historically, these were cash-only services, but are now covered benefits.

                I see positive changes for COBRA benefits and around healthcare portability. Preventing insurance companies from disqualifying people based on pre-existing conditions is another positive change in recent years.

                I see initiatives for moving the population away from “self-pay” to getting people benefits through state-funded programs like Medicaid. The challenge here is that I don’t see an increase in Medicaid funding and that is a concern. If more people are added to the pool, where does the money come from to support this initiative? With states like CA bankrupt, and the federal government $3 trillion in debt, I don’t see this as well thought out plan. Cuts to other programs are a certainty.

                We should all be concerned about healthcare in America, and the plan for the future. With the elderly population expanding, the increase in Alzheimer’s disease, epidemics like autism, and other real healthcare issues facing us, we all need to be concerned and be paying attention.

                I don’t have the solution in my back-pocket to solve America’s healthcare crisis, so sorry, I haven’t solved the Great Mystery. It is one that I am actively following in the news and reading diligently. It impacts all of us. It has great impact on Caregivers and their patients, and we need to stay on top of the changes.