from the world's big
A value-based payment system could revolutionize health care as we know it
The health care payment system is due for a major overhaul.
- Value-based health care focuses on tangible improvements in patient care outcomes.
- The goal is to reduce the per capita cost while improving treatment.
- Current fee-for-service payment models focus too much on quantity and not quality of care.
Throughout the century, miraculous advances in medicine and scientific breakthroughs have brought the health care profession to a new zenith of excellency. Incurable diseases have been eradicated and conditions that were once death sentences are now vanquished with a quick pill or surgical fix.
But underneath all this progress lies a vestigial sore weighing down the entire health care industry – the limited health care financial system. While medical care and technology itself has advanced to greater heights, the underlying business and financial functions are lacking.
The mounting costs of a fee-for-service health care payment model and subsequent lack of oversight on the quality of care is becoming too much to handle for both individuals and employers alike.
A recent report from the Health Care Cost Institute found that per-person out of pocket spending has reached an all time high for Americans under the age of 65 who are covered by employer-sponsored insurance.
Data gathered from that same report shows that employer coverage has risen 44% per enrollee between 2007 and 2016. The total cost of spending on employer health care services has ballooned to an annual cost of nearly $700 billion.
What's the underlying issue for this? The problem may be endemic to a fee-for-service payment model.
Time to shift to a value-based payment system
The current state of payment systems in health care takes the form of disjointed and disparate bill of costs that don't take into account whether or not the treatment was valuable. Let's look at a simple example on why this is so.
- Fee-for-service care - A patient undergoes surgery. They end up getting an infection. On their next visit back to the medical center the patient now bears the cost to treat it.
- Value-based care - A patient undergoes surgery. They end up getting an infection. On their next visit back to the medical center the hospital bears the cost to treat it.
While this is an overly simplified example, it cuts to the heart of the issue. Health care services and payments need to be held accountable for what value they bring and not what laundry list of treatments they doll out.
Fee-for-service models lower quality of care and are a disservice to patients and employers alike. Michael J. Dowling, president and CEO of Northwell Health, argues that the rising costs are intrinsically tied to lower quality of care. "Value-based care ties reimbursement to quality, not quantity of care. The goal is to incentivize better care and lower costs," he writes in "Health Care Reboot".
Dowling imagines a world where the quality of care is the standard rather than the volume of care.
A lot is at stake here. Business as usual is going to be unsustainable for both hospitals, employers and individuals. For institutions like Northwell Health, clinical outcomes are paramount; health care improvement and high-quality care need to become the norm.
And patients agree. In a quest to figure out just what value-based health care means to patients and physicians, The University of Utah conducted a far-reaching survey. The results showed that patients identified a few key characteristics of high-value health care:
- Around 62% considered the quality and effectiveness of their care to be the most important factor of high-quality health care.
- 26% were most concerned with their out-of-pocket costs.
Major companies are already taking note and are springing into action with new plans.
Employer initiatives with value-based health care plans
Are employers doing enough for their employees?
For quite some time, companies tried to cut down on costs using measures like increasing employee expenses and limiting their coverage and access to certain specialists. But now they're realizing that this is not the way to go, and are instead taking a more active role in developing their value-based health plans.
Multinational insurance broker Willis Tower Watson has found that an increasing number of companies are opting to negotiate directly with health care providers to apply value-based payment systems.
According to its survey, in 2017 only 6% of employers were pursuing the aforementioned plans. Twenty-two percent of employers surveyed said they intended to start working directly with providers to change the payment system in 2019.
More promising numbers from the same survey point towards a majority 65% of companies also making this a priority over the next three years.
This rising trend has put forth a lot of new exciting initiatives. On the ground floor, better care is already being seen. One such example is from something called a patient-centered medical home, where a team of medical professionals build a personal relationship with their patient to anticipate their needs and make sure they're cared for in the best manner. This would include screenings based on the patient's age, gender and medical condition.
This approach would be most likely used for patients with high-cost chronic conditions. David Lansky, CEO of the Pacific Business Group on Health, initiated something like this in his company's Intensive Outpatient Care Program.
Lansky explained that his organization:
"...identified 15,000 people with multiple chronic conditions and severe challenges in getting good care, and helped pay for primary care teams that would deliver coordinated care, address social needs, and address mental health needs, all under a prospective payment to the care team."
More and more companies are embracing this new value-based approach. The results are reduced hospitalizations and costs. Walmart's Center of Excellence program has also been leading the charge to cut costs and improve care with an integration of the best care it can provide for its employees.
While this is just the beginning in this new trend, we're already seeing that value-based payment models are incentivizing better care for all.
After a decade of failed attempts, scientists successfully bounced photons off of a reflector aboard the Lunar Reconnaissance Orbiter, some 240,000 miles from Earth.
- Laser experiments can reveal precisely how far away an object is from Earth.
- Scientists have for years been bouncing light off of reflectors on the lunar surface that were installed during the Apollo era. But these reflectors have become less efficient over time.
- The recent success could reveal the cause of the degradation, and also lead to new discoveries about the Moon's evolution.
A close-up photograph of the laser reflecting panel deployed by Apollo 14 astronauts on the Moon in 1971.
NASA<p>The technology isn't quite new. During the Apollo era, astronauts installed on the lunar surface five reflecting panels, each containing at least 100 mirrors that reflect back to whichever direction it's coming from. By bouncing light off these panels, scientists have been able to learn, for example, that the Moon is drifting away from Earth at a rate of about 1.5 inches per year.<br></p><p style="margin-left: 20px;">"Now that we've been collecting data for 50 years, we can see trends that we wouldn't have been able to see otherwise," Erwan Mazarico, a planetary scientist from NASA's Goddard Space Flight Center in Greenbelt, Maryland, <a href="https://www.nasa.gov/feature/goddard/2020/laser-beams-reflected-between-earth-and-moon-boost-science" target="_blank" rel="dofollow">told</a> NASA. "Laser-ranging science is a long game."</p>
NASA's Lunar Reconnaissance Orbiter (LRO)
NASA<p>But the long game poses a problem: Over time, the panels on the moon have become less efficient at bouncing light back to Earth. Some scientists suspect it's because dust, kicked up by micrometeorites, has settled on the surface of the panels, causing them to overheat. And if that's the case, scientists need to know for sure.</p><p>That's where the recent LRO laser experiment comes in. If scientists find discrepancies between the data sent back by the LRO reflector and those on the lunar surface, it could reveal what's causing the lunar reflectors to become less efficient. They could then account for these discrepancies in their models.</p>
Studying the Moon's core<p>More precise laser experiments could also help scientists learn more about the Moon's core. By measuring tiny wobbles as the moon rotates, past laser experiments revealed that the satellite has a fluid core. But inside of that fluid could lie a solid core — one that might've helped to generate the Moon's now-extinct magnetic field.</p><p>However, confirming that hypothesis will require more precise measurements — and the continued success of laser experiments involving the LRO, or reflecting panels installed on the Moon during future missions.</p><p style="margin-left: 20px;">"The precision of this one measurement has the potential to refine our understanding of gravity and the evolution of the solar system," <a href="https://science.gsfc.nasa.gov/sed/bio/xiaoli.sun-1" target="_blank">Xiaoli Sun</a>, a Goddard planetary scientist who helped design LRO's reflector, told NASA.</p>
Ever wonder why soft hair can dull a steel razor? So did scientists at MIT.
- Steel is fifty times harder than hair, yet shaving razors dull in a hurry.
- A new study finds much of this is caused by hair cracking razors at points of imperfection.
- The findings may lead to new ways of making razors that last longer.
It surprises me it took this long for a scientist to look at their shaving razors under a microscope.<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzU1NjY3OS9vcmlnaW4uZ2lmIiwiZXhwaXJlc19hdCI6MTY1NTE0MTkwM30.LSp_rimRO6vHeMMlifEbuKjUS9bcvkSaMzRqh8MyHlo/img.gif?width=980" id="a6de5" class="rm-shortcode" data-rm-shortcode-id="3778bbe9f14500b64391091a5ea08fa4" data-rm-shortcode-name="rebelmouse-image" />
An extremely magnified image of a razor blade cutting hair.
G. Roscioli<p>Lead author Gianluca Roscioli grew his facial hair out for three days before <a href="https://www.smithsonianmag.com/smart-news/why-razors-are-dull-within-weeks-according-science-180975534/" target="_blank">shaving</a>. He then brought his razors into the lab to examine them under an electron microscope. While they expected to see even dulling on the blade edge, they instead noticed strange C-shaped chips missing. Intrigued, they attached a camera to the microscope so they could record the blade cutting the <a href="https://www.sciencemag.org/news/2020/08/your-hair-can-crack-steel-when-it-hits-right-spot" target="_blank">hair</a>. At the same time, they investigated the properties of the razors at the microscopic level.</p><p>This apparatus revealed that, when the razor blade hit the hairs at non-perpendicular angles, small cracks would form in the razor blade. These tended to develop in boundary areas between where the steel was harder and where it was softer due to differences in the properties at each location caused by the manufacturing <a href="https://www.newscientist.com/article/2251202-we-just-figured-out-why-shaving-soft-hair-blunts-steel-razor-blades/" target="_blank">process</a>. Over time, these cracks grew into chips. While these chips are too small to see with the naked eye, they were large enough to reduce the blade's effectiveness.</p><p>Roscioli told <a href="https://www.smithsonianmag.com/smart-news/why-razors-are-dull-within-weeks-according-science-180975534/" target="_blank" rel="noopener noreferrer dofollow">NPR</a>, "The size of the chips are about 1/10 of the diameter of a human hair."</p><p>The chips can be caused by hair of any thickness and appear to be unavoidable in blades with standard imperfections. </p><p>The finding surprised other scientists, who also quickly accepted the explanation. Professor Suveen Mathaudhu of UC Riverside explained to <a href="https://www.npr.org/2020/08/06/898577234/cutting-edge-research-shows-how-hair-dulls-razor-blades" target="_blank" rel="noopener noreferrer dofollow">NPR</a> that he had expected a larger role in the dulling process to be played by corrosion but that the findings made a great deal of sense. Other scientists expressed how impressed they were by the quality of the images and the difficulty of the study. </p>
How can we possibly use this information?<div class="rm-shortcode" data-media_id="ELqsmO1M" data-player_id="FvQKszTI" data-rm-shortcode-id="2295233989512b59279237452c0e0076"> <div id="botr_ELqsmO1M_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/ELqsmO1M-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/ELqsmO1M-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/ELqsmO1M-FvQKszTI.js"></script> </div> <p>The study determined that part of the reason for this chipping is the imperfections in the steel used to make the blades, specifically, the lack of uniformity in the composition of the steel at the microscopic level. At least partly, these imperfections are due to the nature of the production process and can be reduced through alternative methods. This study's research team is also working on a new material with more structural uniformity as a possible solution.</p><p>These findings may one day lead to longer-lasting razor blades. Given that Americans throw out two billion blades each <a href="https://www.usatoday.com/story/news/nation/2019/08/07/landfill-waste-how-prevent-disposable-razor-plastic-pollution/1943345001/" target="_blank">year</a>, such a discovery's environmental impact would be tremendous.</p>
You're always in control of your breath.
- Anxiety is triggered environmentally and emotionally, but a physiological response quickly follows.
- Calming breathing techniques help to tamp down the physiological response of anxiety.
- The following four exercises are known to help calm anxiety and develop focus.
Stressed? Use This Breathing Technique to Improve Your Attention and Memory, with Emma Seppälä<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="ac308f8ef7490814bcb4c1841725cf35"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/NrJZu6bGyHg?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><h3>Alternate Nostril Breathing</h3><p>Emma Seppälä, science director at Stanford Center For Compassion And Altruism Research And Education, says American culture values intensity yet undervalues calmness. We never shut off. While intensity has its place, every animal in nature inherently knows the necessity of rest in order to store up energy for when it's actually needed. Americans are careless with our energy reserves, which is why so many of us are chronically tired, overworked, and stressed out. </p><p>Seppälä knows that breathing changes our state of mind. She recommends a popular yogic breathing technique, <em>nadi shodhana</em>, also known as alternate nostril breathing. </p><p>Place the index and middle fingers of your right hand on your forehead. Use your thumb to close your right nostril while inhaling through the left nostril, then close the left nostril with your ring finger and exhale through your right nostril. Repeat this for at least two minutes, then sit quietly for another minute or two, breathing normally. </p><p>There are many variations of this technique. My favorite is a four-cycle breath: inhale for a count of four through one nostril, retain your breath for a count of four, exhale for four, hold your breath out for four. If you're new to this breathing technique, retention might initially create more anxiety than it relieves, so try the basic inhale-exhale pattern until you can last for at least five minutes before moving onto breath retentions.</p>
Mind Hack: Combat Anxiety with This Breathing Technique<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="0cd55bb6ac6c7dd5daab3c29b7a82843"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/7xalaT2FwS8?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><h3>Power Breath</h3><p>Game designer and author of "Superbetter," Jane McGonigal, recommends the Power Breath: exhale for twice as long as you inhale. She says this will shift your nervous system from sympathetic to a parasympathetic tone—you'll calm down. Simply sit comfortably, close your eyes, and begin by inhaling for a count of four and exhaling for a count of eight. </p><p>This is also a popular yoga breathing technique. As with <em>nadi shodhana</em>, it can initially kick up rather than diminish anxiety. If you find long exhales challenging, begin by inhaling and exhaling at an even rate: a count of four in both directions. Then try to slowly increase your exhale to a count of five, six, and so on. Longtime practitioners can inhale for a count of four and exhale for a count of 50. As with any muscle, you can train your breathing. The benefits are immense. </p>
Breathing Techniques to Help You Relax<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="56511aaa4d1c06cc65077b8daf7670fb"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/RHpTR2wRc8c?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><h3>Focus Word Breathing</h3><p>Lolly, a Mind-Body Specialist at the University of Maryland Heart Center, offers what she calls Focus Word Breathing. Traditionally, this is known as Mantra meditation. Choose a word that has meaning to you—<em>calm</em>, <em>grace</em>, <em>ease</em>—and repeat it during every inhalation and exhalation. As your mind wanders, the word becomes a sort of flagpole that you've mentally planted to bring you back to this moment. </p><p>As a former sufferer of anxiety disorder, I remember how important my thoughts were when having a panic attack. The power of the physiological symptoms increased when I dwelled on negative thoughts. This spiral felt like being sucked into a vortex. By contrast, when I was able to redirect my thinking, the symptoms lessened. </p><p>Mantra meditation never completely worked during an attack. By that point, my physiology had been hijacked. But as a regular practice, this breathing technique is powerful. Think of it as training for the big game of life. You teach yourself to focus on beneficial words. Your attention goes where thinking leads you, but you also have control of your thoughts. By integrating a mantra with breathing, you're priming your mind to focus at will.</p>
How to do Viparita Karani (Legs Up the Wall) w/ AnaMargret Sanchez<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="6ebcd48808f1ef73d5d35b9b4f58e8e8"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/YHxoiq1YivE?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><h3>Deep Belly Breathing</h3><p>This exercise is commonly used by yoga instructors to bring their students into Corpse Pose (Savasana). Place your hands over your stomach while lying down and focus your attention there. Take deep, even breaths into your hands. As with the last technique, focus your mind there. Relax the muscles at your extremities: your toes, fingers, and forehead. Allow yourself to melt into the floor. </p><p>I love doing this breath while in <em>Viparita Karani</em>, otherwise known as Legs Up the Wall posture. The video above explains how to enter this pose; a blanket or pillow under your lower back makes the posture comfortable. Once there, I practice deep belly breathing. This technique always calms me down. I've recommended it to friends suffering from insomnia; they all responded with positive anecdotal feedback. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank" rel="noopener noreferrer dofollow">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank" rel="noopener noreferrer dofollow">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank" rel="noopener noreferrer dofollow">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
SMARTER FASTER trademarks owned by The Big Think, Inc. All rights reserved.