Health care financing is out of date: Large employers must put their weight behind needed changes

April 9, 2021 / By L. Gordon Moore, MD

Health care payment is about how we write the checks. Health care finance is about how we design the way money flows.  We’re living in a system built by good people with the best of intentions that has eroded over time into a system that fails to deliver what we want from health care. We’re missing too many opportunities to help people be well, prevent disease, slow or reverse disease progression and avoid landing in the emergency department or hospital.

Do we continue to pay ten times to clean up after these missed opportunities or one time to prevent the problem in the first place? We need cardiologists and stents and oncologists and chemo, but could we reduce their waiting lists a bit by helping people better manage their lifestyles so they are less likely to develop heart disease and cancer? 

We pour money into cancer research and therapies (and should not stop), but we throttle primary care and public health.  I think most people would say “Umm, yeah, I’d prefer to prevent the heart attack or cancer. Let’s work more on that prevention stuff.”

Doing this requires shifting focus and funding upstream.  We need to refresh policies that get in the way.  We have legislated policies holding us to circumstances that might have been real 40 years ago, but fail to serve our current and future needs. Consider how long we’ve known that telemedicine is a good thing for people (decades) compared to when health care financing recognized this as legitimate work (COVID-19 pandemic).

Leaders of large companies have considerable influence on health care financing.  The 40 jumbo employers who are members of the Purchasers Business Group on Health (PBGH) are expressing their frustration with spiraling health care costs with no commensurate increase in quality. Employers should be fed up with the lack of real progress on health care costs in the U.S. and should be demanding bold action.  The bold action is not a buzz word or the latest app – it is demanding that health care finance recognizes and supports a solid foundation of primary care.

We need to fund the full scope of primary care work so that they have the resources to help their patients to be well, stay well, manage conditions to the best of their ability and to be fully present, productive members of society. 

Most developed countries spend around 15 percent of the health care dollar on primary care while the U.S. spends about 7 percent. Unless we want to keep cleaning up after the missed opportunities at top dollar, this needs to change. The changes we should make are well described by decades of research and are available on the web sites of many groups interested in helping us get to a more rational health system (some listed below).

• The Larry A. Green Center
• The Primary Care Collaborative
• The Commonwealth Fund
• The Milbank Memorial Fund
• The Purchasers Business Group on Health
• The Center for Professionalism & Value in Health Care
• The American Academy of Family Physicians

Come listen to the 3M Inside Angle podcast and hear Dr. Rebecca Etz, Co-Director of the Larry A. Green Center at Virginia Commonwealth University, describe why we must change health care financing to get the health system we need now.

Dr. Gordon Moore is Senior Medical Director, Clinical Strategy and Value-based Care for 3M Health Information Systems.