We don’t need a single-payer system. We need to align healthcare incentives to deliver better outcomes

 

By Dan Sontupe, associate partner and managing director of the Value Builders in The Bloc

 

As of July 2019, the Kaiser Family Foundation reports that 51 percent of Americans now support single-payer, government-funded health plans. That support has remained at or above 50 percent since February 2016 — due largely to the widespread desire for expanded Medicaid and Medicare and universal coverage.

This support reflects a dire need: Current exorbitant healthcare costs and inadequate insurance leave many patients without essential care that could improve or save their lives. However, a single-payer market is not necessarily a panacea.

Pharmaceutical marketing and population health

In a single-payer market, much of the need for pharmaceutical companies to market would be eliminated. After all, they wouldn’t have anything to sell. Without marketing, pharmaceutical companies would have less incentive to introduce things like telemedicine to support healthcare professionals in providing better outcomes.

The simpler, more effective solution would be for the government to design Medicare Part D plans to take outcomes, not just cost, into account. That alone would incentivize plans to worry less about making sure high deductibles are paid and more on helping patients adhere to medications.

The government should certainly weigh this logic against the legal restrictions prohibiting pharmaceutical companies from partnering with commercial health insurance – this prevents full alignment.

Aligning goals for better outcomes

As of now, Medicare looks at drugs in a vacuum instead of as part of overall healthcare expenditures. But with the incentives of Medicare A, B, and D aligned – much like they are in Medicare Advantage – drugs would play a role in lowering costs and reducing physician visits. It would create a partnership between hospital systems, health plans, pharmaceutical and device manufacturers, and patients. Typically, if Medicare executes, the commercial health plans will follow.

In a shared population health program, pharmaceutical companies could invest in partnerships with commercial insurance and hospital systems to support at-risk patients. With less of a competitive emphasis, everybody could work toward alleviating pressing medical issues. Removing the barriers preventing pharmaceutical companies from collaborating and aligning incentives with other players could bring everything full circle – and it’s up to the government to permit this collaboration.

Let’s make it about the outcome. Every stakeholder has a role here, and it’s less about specific brands that cost and do more or less. If we can align incentives and think bigger, better, and beyond branded tools, we could create a community-based healthcare ecosystem that thrives no matter how many payers are involved.