Want Improved Health? Improve Your healthCARE

Introduction

Why is the health of Americans so much worse than that of other countries that spend less on healthcare than we do? Even though many of the greatest life-saving and life-extending medical advances of the last century have come from the U.S.A, nonetheless we often have very disappointing health results for our people.

For instance, the average life expectancy at birth for Americans has dropped in the last few years, and now sits at about 80 years (as of 2021). Most western European countries and Japan have life expectancies of over 83-85 years. Average U.S. infant mortality rates are at a dismaying 5.4 deaths per thousand births, with the European average at 3.3, and Japan at 1.7—less than one third that of the U.S.

What makes things worse is the fact that the U.S. spends much more on healthcare per person than any of those other countries mentioned. But you wouldn’t believe that based on the results we’re getting and what it’s like to try to get the care you need. For many Americans, even the ones who do have some kind of insurance coverage, it’s often hard to get an appointment with a primary care provider, and many people feel rushed in and out of the exam room when they get there for their appointment. The providers themselves also feel rushed, which is a prime factor in their robust burnout rate of almost 50%.

And, of course, many Americans have no healthcare insurance coverage at all. As of early 2024, approximately 8.2% of Americans—equating to about 27.1 million people—were without any form of health insurance. This marks an increase from 7.6% in 2023, reversing a trend of declining uninsured rates observed in previous years.

Why are things the way they are?

While the origins of the current system of healthcare insurance make for a longer story, a large part of the problem of poor healthcare results and rushed office visits relates to how American healthcare providers have been paid. Payment has been based on what is called fee-for-service. Every time someone has a medical office visit, has blood drawn for testing, shows up at an emergency room or hospital, or has some kind of procedure done, that event or series of events gets billed to somebody for payment. In other words, no healthcare provider or facility gets any payment unless they do something to somebody. That’s been the basic business model of U.S. healthcare for longer than all of us have been alive.

So those healthcare professionals or facilities don’t get PAID unless they do something to somebody —whatever that “something” is.

HealthCARE instead of HEALTH—a big problem

Until recently there has been very little incentive to focus on things that improve HEALTH, like making sure people have enough nutritious food or can afford the medications they have been prescribed, because there has been no way for the healthcare industry to get paid for it. Oh, we have lots of procedures and pills to throw at people once they get sick with diabetes, heart disease, or whatever, but no financial incentive to talk about and provide the kind of information and supplies that might keep people from getting sick in the first place.

Also, the business of medicine has gotten more and more expensive to run. Much of this has been caused by the need for increased staffing to deal with the incredible complexities of medical reimbursement. For instance, insurance companies, including Medicare, increasingly are requiring prior authorization for many procedures and treatments that once were unquestioned. It takes more medical office staffing to give the same amount of care.

There is a Solution

American healthcare is in a rut, and our health often is in a rut because of it! But there is a better way—it’s called value-based care (VBC). VBC has been around for a very long time. Stories have been passed down in China from many centuries ago that, in some places, Chinese doctors were paid based on keeping people healthy. If a patient became ill, those doctors didn’t get paid until those people got well again. They believed that the best kind of care kept people healthy. That’s what we now call preventive medicine.

VBC defined

Value-Based Care is a healthcare delivery model in which healthcare providers--hospitals and physicians--are paid, just like those ancient Chinese doctors were paid, based on patient health outcomes rather than on the amount of services provided. That creates an emphasis on prevention—keeping people well, instead of production—doing things to people.

VBC in other countries

A primary reason that the western European nations and Japan get better healthcare results for their people is that they invest heavily in preventive measures, such as providing nutritious food for folks in need and making sure that people can get the preventive health services they need—whatever it takes to keep people from getting sick in the first place.

VBC in the U.S.—a way forward

Fortunately, some medical groups and facilities in America are providing VBC now. There are programs available, in regular Medicare, Medicare Advantage, and commercial plans, where the providers are paid a certain amount for each patient they are caring for. The beauty of this arrangement is that they are then free to spend that money in any way that seems best for each patient. For some people, they may need special treatments or procedures. Others may need access to nutritious food or care at home. Still others will only need a few medications and annual wellness visits with their primary care provider.  At its best, VBC allows for all those things to happen, as each person being cared for has need.

How to find a VBC primary care provider

This wonderful way of caring for Americans is becoming more available to more people. But how can you find this kind of care in your own area? You’ll have to do your own research—asking questions, looking at alternatives. Here are a few ideas that may be helpful:

1.    Medicare Advantage plans are graded based on how well they do on maintaining the health of their members. Be sure to look for four or five-star plans in your area , and ask for plans with a value-based option.

2.    Use the Medicare website called Medicare Compare. This is a good source for finding out which plans in your area have the best quality ratings.

3.     Accountable Care Organizations (ACOs), which may be available in your area for both Medicare and commercial insurance members, are known for providing high-quality, value-based care to their members.

4.    For employer-sponsored health plans, ask your HR department or benefits manager whether your employer offers plans that use value-based models.

5.    Choose health systems known for VBC. For instance, Kaiser Permanente has provided VBC for many decades now. The Geisinger Health System, based in Pennsylvania, is well known for providing VBC for their members. And there are newer organizations, such as the Millenium Physician Group in Florida, that were created to provide VBC.

6.    Medicaid—a few states, including Oregon and Colorado, already have strong VBC options for their Medicaid members, and other states are starting to move their Medicaid plans in that direction.

7.    Ask your present healthcare provider if they provide VBC. And don’t be afraid to make a change if you don’t get the right answer.

What to expect as a patient

As a patient of a VBC primary care provider, you should expect an emphasis on preventive health services such as annual wellness visits, preventive vaccinations, and regular bloodwork, along with patient education on how to keep your best health. Also, these providers should allow more time for your office visit so that you have enough time to share with your provider more of what is going on with you and your health.

Conclusion

The present U.S. healthcare system can be very difficult and frustrating to find your way around, like being lost in the forest without a map or compass. It’s all too easy to get less than the best healthcare available. But fortunately there’s a way out of those woods—Value-Based Care.

References

OECD (Organisation for Economic Co-operation and Development) Health Statistics 2024 https://www.oecd.org/en/data/datasets/oecd-health-statistics.html

The World Factbook: Life Expectancy at Birth  https://www.cia.gov/the-world-factbook/field/life-expectancy-at-birth/country-comparison/

The World Factbook: Infant Mortality 2024 (est.) https://www.cia.gov/the-world-factbook/field/infant-mortality-rate/

T. Colin Campbell Center for Nutrition Studies (Updated February 21st, 2025)--What if doctors were paid to keep people well?

https://nutritionstudies.org/what-if-doctors-were-paid-to-keep-people-well/

CMS (Centers for Medicare & Medicaid Services) Value-Based Care—definition and key concepts https://www.cms.gov/priorities/innovation/key-concepts/value-based-care

Health Affairs October 5, 2023--Making The Promise Of Value-Based Care Meaningful To Consumers https://www.healthaffairs.org/content/forefront/making-promise-value-based-care-meaningful-consumers

Medicare Compare https://www.medicare.gov/care-compare/

Value Based Care for Oregon Medicaid members https://www.oregon.gov/oha/HSD/OHP/Pages/cco-plans.aspx

Value Based Care for Colorado Medicaid members https://www.healthfirstcolorado.com/

Assessed and Endorsed by the MedReport Medical Review Board