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Wednesday Jul 03, 2019

Health Spending Keeps Going Up; Why Are Outcomes Worse?

Forget blood tests. A new artificial intelligence platform(www.mobihealthnews.com) promises to detect elevated potassium levels using data from electrocardiograms.

[Dollar sign cracked floor, Financial crisis.]

It's just one of many high-tech innovations we are seeing in medicine. Facial transplants. Precision medicine in cancer treatments. 3D printing of medical devices. Yet despite our advances in some of the most complex areas of medicine, a disturbing trend is emerging: Our health care system is falling backward on the basics of keeping people healthy.

We've all seen the troubling graph(www.huffpost.com) showing the U.S. health care system's per capita spending and average life expectancy benchmarked against those of other countries. We have exorbitantly high costs with lagging outcomes. But the fact that key health outcomes are on the decline is cause for renewed alarm.

Deaths from alcohol overdose rose 37% between 2005 and 2017, and deaths from drug overdose soared 115% during the same period, according to the Commonwealth Fund's recently released 2019 Scorecard on State Health System Performance.(www.commonwealthfund.org)  

Maternal mortality rates also are worsening. And those rates are more than three times worse for black women than white women, at 40 deaths per 100,000 compared to 12.4 deaths per 100,000.

We have screening tools for sexually transmitted infections, in addition to a public health infrastructure that's set up for tracking STIs and proven treatment options. Still, rates of chlamydia, gonorrhea, and syphilis continue to climb.(www.ashasexualhealth.org)  

Stat after stat highlights dismal trends. U.S. suicide rates are the highest they have been(time.com) since World War II, and the increase among children ages 10-14 has been faster than that seen in any other age group. Even the rate of death after falls in the elderly more than doubled between 2000 and 2016.

All this, despite the fact that per-person spending in the U.S. health care system is at an all-time high,(fortune.com) begs the question: Why are we spending so much more for health care and seeing worse outcomes in these basic areas of preventive, reproductive and mental health?

The answers are complex and nuanced in each of these areas.

Our health care system is still home to large inequities in access and social determinants of health. Stigma associated with sexual and mental health care persists. Furthermore, we are seeing these worsening outcomes amid a serious macro-economic trend of a growing wealth gap and deepening household debt.

Young people aren't getting screened for STIs(khn.org) because of a lack of access to clinicians, in addition to inadequate sex education. And as for patients who actively seek help for their alcohol, drug use or mental health issues -- they face barriers of cost, limited options and long waits.(www.thenationalcouncil.org)

Ultimately, all of these trends indicate we are in the middle of a primary care crisis.

This failure can be traced to our society's lack of investment in primary care and public health. To satisfy regulatory demands, family physicians are paying more for EHRs and overhead, while seeing no corresponding increase in reimbursement. With the inception of value-based care and its promise of enhanced payments, FPs are often left straddling outcomes-based expectations in a fee-for-service world. We are taking on the additional burden of tracking outcomes without the support needed to actually improve them. This metric-driven approach has not helped our patients. Click-box medicine is not getting us where we need to be.

As we continue to focus on where dollars flow, it's clear that core areas in medicine aren't getting the attention or funding they deserve. But primary care payment reform isn't the only solution.

A system failure of such proportion calls for innovation. We should challenge our colleagues, our elected officials and the technology we use to urgently focus on solutions.

Digital innovation seeks to step in where our system has failed. For example, patients with mental health issues are accessing help through platforms such as MindStrong.(mindstronghealth.com) Changing primary care delivery models, as well as strengthening the primary care workforce, could help reverse the alarming trends above.

We can shift our medical culture when we start with the patient. We have vetted screening tools and evidence-based treatments; the vital next step is getting these to the patients who need help the most.

Natasha Bhuyan, M.D., is a board-certified family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan.(twitter.com)

Read other Fresh Perspectives posts by this blogger.

Posted at 11:35AM Jul 03, 2019 by Natasha Bhuyan, M.D.

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