Trump wants to take medicaid outside the doctors office

This article describes the type of innovation and disruption required to ultimately break the entrenched-legacy-health-system grip that keeps us on a path of rising costs and self-serving behaviors. The key sentence to ponder is:

“ services account for only about 20 percent of what keeps people well. The rest is determined by the social determinants of health," meaning where people live, what they eat, their social networks, transportation, jobs.

In response. the Trump administration is proposing that government health insurance programs such as Medicaid and Medicare be allowed the flexibility to pay for such services as part of innovation experiments.

This is more than expected but also less than desired. First, big kudos for breaking out of the trap of paying for only in-person doctor office visits and hospitalizations. On the downside, as a practicing physician I am concerned about encouraging people to use the “sickness system” as a gateway to getting social services (see workers comp and disability as examples). But perhaps this is the opening for even bigger changes:

The hospital is dead: move care out of the hospital and out of clinics and to the phone and to the home.

Move care away doctor-based control and to less expensive, less regulated settings.

(We remain extremely bullish on innovative systems that deliver care via digital and in novel retail settings).

Acknowledge that the current medical system is a “sickness system” designed for complex acute and chronic illnesses, whose providers and systems are incapable of delivering “wellness” or fostering and maintaining health. Delivering health will require different businesses and different kinds of people.

Read: Wash Examiner: Trump administration looks to take Medicaid outside the doctor's office

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