Discussions, questions for post-reform healthcare

BOSTON—We are in an era of unprecedented advanced in medical technology but it is a case of ‘the best of times and the worst of times,’ said Phillip Polakoff, MD, MPH, MEnv.Sc., national health advisor, speaking at Medical Informatics World.

Those advances offer numerous benefits but are expensive. Polakoff said public health does not unite with healthcare delivery and we have unsustainable healthcare costs.

As healthcare works toward more patient-centric care, the industry also must address privacy and security concerns, how to get more personal data into EHRs and transparency on pricing and claims management.

Many conversations need to occur, he said, from what exactly is care—one-on-one patient-provider visits? Telemedicine?—to the definition of informatics. Providers have their own views while payers view informatics as risk management.

While there has been much buzz about wearables, Polakoff said the sector needs to know who is wearing them and what are the benefits. There are more than 100,000 healthcare-related apps but how many are really used and what is the validity, he posed.

The move to value is happening, he said, and it will require significant changes in culture, capabilities and business structures. There will be new approaches to care delivery and patient relationships as well. “Patient-centered will be an imperative in a post-reform landscape.”

Healthcare needs to restructure its infrastructure to increase the speed of change. The Affordable Care Act has led to many more covered individuals. He said the Medicaid numbers in California have gone from 8 million to 12 million—not good considering the lack of coordination, fragmentation and unsustainable costs.

Polakoff predicted a decrease in revenue and fewer inpatient beds. “We need to invest in a foundation of lifelong physical and mental well-being in children. We need to create communities that foster health-promoting behaviors.”

He identified the following five critical “Ps”:

• Personal health
• Population health
• Public health, which needs to be revitalized and integrated
• Place
• Political will

Given the amount spent on healthcare in the U.S., Polakoff asked, “What’s the return on our $2.9 trillion?”