“Coordinated Care for All”

(A plan that offers 40% cost savings over "Medicare for All", a savings of $1.4 Trillion annually)

 

The focus of the plan is on improving cost-effectiveness, while also improving the quality of care delivered. This plan has been endorsed by the Case Management Society of America (CMSA)

 

Plan Features:

Prediction of risk: Predicts risk based on genetic predisposition (voluntarily submitted), family history and current medical status.

 

Education: Provides education to the patient on how to prevent deterioration of a particular condition.

 

Prevention: Emphasizes the importance of preventing disease through moderation in diet and exercise. There is a certain amount of anticipated non-compliance, which is accounted for. 

Cost Containment:

-Pharmaceutical legislation (as with substance abuse and large increases in the prices of medication).

-Improved standardization of hospital/surgery center billing practices.

 

Efficiency:

-Consolidation of medical records (though privacy should be maintained).

-Telemedicine (to improve access to care).

-Medical case management (which is voluntary and based on patient consent):

Medical case management involves a Registered Nurse (RN), also known as a Nurse Case Manager (NCM). They are certified (as with a CCM credential, which stands for Certified Case Manager). NCMs shorten the recovery process.

Medical case managers:

 

-Facilitate communication among the involved parties (i.e., patient/family, provider and adjuster). 

-Coordinate complex care, which results in the avoidance of treatment delays, miscommunication and misunderstanding (this type of complexity is often too difficult for adjusters to manage on their own).

-Know the best providers and ancillary services vendors.

-Translate medical jargon to layman's terms (for the adjuster) and vice versa regarding the provider.

-Have a general overview of health from a wider macroscopic perspective, and understand the more efficient pathways to recovery.

-Identify when over-utilization occurs.

-Track a patient’s progress with regard to disease management.

 Medical case management is not utilized for healthy patients. However, telephonic case management (working behind the scenes) is utilized for less healthy patients and field (onsite) case management is utilized for complex/catastrophic patients (which accounts for the greatest health care costs).

 

Assimilating these concepts:

This plan would work best utilizing a prevention-based, centralized computer system (case management system) with artificial intelligence (AI) functionality that predicts risk and automatically provides education, consolidates medical records and triggers telephonic and field case management based on a pre-determined set of criteria.

While all of this can be applied to a model for a single-payer source (Universal Healthcare), the same ideas could be applied to the private sector as well. The allowance of pre-existing conditions and competition within the private healthcare sector are inclusive in the plan.

 

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