Exploring Innovative, Alternative Healthcare Models in the US

Exploring Innovative, Alternative Healthcare Models in the US

Raj Selladurai (Indiana University Northwest, USA), Roshini Isabell Selladurai (In His Image Family Medicine Residency, Ascension St. John Medical Center, USA) and George VandeWerken (Providence Bank, USA)
Copyright: © 2020 |Pages: 22
DOI: 10.4018/978-1-7998-2949-2.ch002


This chapter explores, discusses, analyzes, and presents some recommendations for new, innovative alternative healthcare models to the traditional insurance and healthcare models that currently exist. These include a revised and enhanced hybrid model of healthcare; healthcare cost-sharing faith-based model; healthcare cost-reduction corporate partnership model (for example, Amazon, Berkshire Hathaway, and JPMorgan Chase partnership); direct primary care model; and wellness program model including subscription type payment services, concierge medicine services, networks of primary care physicians providing patient retention, personalized medicine, and preventive care (MD VIP for example). Significant outcomes such as lowering healthcare costs, enhancing the quality and delivery of healthcare services, improving patient satisfaction, and promoting overall sustainability are addressed, including their implications for various stakeholders.
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After many lengthy discussions and controversial debates in the US Congress related to healthcare, the Affordable Care Act (ACA) was passed in 2010. It was supposed to have been a more sustainable healthcare system and was designed primarily to address the lack of healthcare insurance coverage for the uninsured millions of Americans in the country. But several years later, despite providing expanded coverage for millions of Americans, the ACA faces significant serious challenges and shortcomings. Studies have shown that many people still are unable to get access to affordable healthcare insurance, that the costs of healthcare are skyrocketing in many states and regions of the country, and that several insurance companies are exiting from unprofitable markets, thereby leaving millions stranded to fend for themselves (Stack, 2016). Also, healthcare and healthcare reform in the US continue to be much-discussed but controversial topics and will likely be among the top issues on the agenda for both parties in the 2020 election year.

Among the current severe concerns facing the US healthcare system, the high cost of healthcare is perhaps the most significant detrimental factor that needs to be addressed. Healthcare costs in various healthcare areas are exorbitantly high and continuing to increase. National health expenditures (NHE) have skyrocketed over the years, from $27.2 billion in 1960 to $3,492 billion in 2017 (Centers for Medicare and Medicaid, 2018). Further, the NHE per capita amount has increased tremendously from $146 in 1960 to $10,739 in 2009 (Folland et al., 2013). Also, a Harvard School of Public Health research study showed that the cost of medical malpractice in the United States is about $55.6 billion a year and that a significant amount estimated to be $45.6 billion is spent toward defensive medicine practiced by physicians, attempting to avoid litigation and lawsuits (Mello, 2010).

Furthermore, a recent study showed that administrative costs accounted for about 25 percent of total hospital costs in the US -- more than $200 billion -- which was higher than all other nations with Canada and Scotland being the lowest. The US would have saved $150 billion in 2011 alone if US per capita spending was similar to Canada's or Scotland’s lower spending levels (Himmelstein, 2014). In the another University of British Columbia and Harvard University joint study, researchers found that US healthcare spending far exceeds other countries, with hundreds of billions of dollars being spent on administrative costs rather than the quality of healthcare for patients or on goods or services related to them (Gottlieb & Shepard, 2018). Therefore, it would seem that the urgent goal and focus of new, innovative models should be on the development and implementation of high-quality healthcare options to be offered at optimal, low cost for all in the US.

Key Terms in this Chapter

Enlightened Self-Interest: Pursuit of profit or self-interest with social responsibility perspectives to be sustainable in the long term.

Corporate Partnership Plans Model: Companies that partner together in pooling their resources to offer innovative healthcare plan/s that would benefit all the companies’ employees.

Innovative Alternative Model: New healthcare-related change/s to the existing system, which involves implementing or putting into action an alternative strategy, plan, or program that may be measured in terms of effectiveness.

Patient/Customer-Centricity: The healthcare provider/organization emphasizes a total focus on the patient and is customer-centered.

Faith-Based Plans Model: Healthcare plans that are related to Christian faith and values in this context.

Hybrid Plans Model: A blending or combination of two or more alternative plans into one plan.

Direct Primary Care Plans Model: The physician and healthcare provider/s interact directly with their patients, in terms of more direct contact, time spent, services provided, direct payment agreements, etc.

Stakeholders: All of the individuals and groups that have some “stake” or interest in the organization.

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