In Healthcare it Takes a Village – But What Kind of Village Will it Be?

Originally published on Medium

As the country's medical communities increasingly form Accountable Care Organizations (ACO) to share resources and responsibilities for treating Medicare patients, some use the phrase. It takes a village to care for a patient, and the ACO model that village.

Healthcare delivery is indeed a group effort. When a multidisciplinary approach is used to tackle problems of human health, patient outcomes will improve. But is this village just for patients treated by large health systems, or will it be a diverse enough town to include patients who visit independent doctors?

So, will there be freedom of choice in this village? Or will all the critical decisions be dictated from above?

Suppose our healthcare system will be genuinely inclusive and democratic as we move to the ACO model. In that case, the survival of independent doctors is more important today than ever before.

Independent medical practices have been gradually vanishing because of cost pressures and administrative and regulatory burdens. Many physicians find it easier to join a more significant health network than face these challenges with limited resources. The loss of these practices takes away healthcare access for many patients in underserved parts of the country and reduces the number of treatment options in the overall healthcare system.

Doctors who are part of managed care have been combining resources and sharing the responsibility of implementing Medicare programs. Networks of independent doctors are joining in this restructuring of healthcare delivery in America. But if these independent practitioners continue to close their doors, the number of patients who can benefit from the "village" of healthcare providers will get smaller. That's not the direction we should be moving in.

Additionally, suppose every doctor and healthcare administrator in the village is a part of the managed-care system. In that case, it means that every treatment decision for every patient will be--to some extent--dictated by a small group of people at the top. Managing healthcare for large populations of patients means there must be strict protocols for the delivery of healthcare.

While these protocols are essential, and while dedicated healthcare providers determine them, they can never guarantee the best treatment course for all patients all of the time simply because there is no "one-size-fits-all" in healthcare.

Independent doctors and medical clinics offer more choices to patients, and they represent independent treatment decisions.

Many patients in America live in areas not adequately covered by the larger health systems, including inner cities and rural areas. Under the current ACO model, too many of these patients will be left out of the village.

Also, too many patients within the village will have important treatment decisions dictated by policies that their doctor did not write but by the village leaders. These leaders have the best intentions, but they are removed from individual patients' day-to-day diagnosis and treatment. That is just one more reason why America cannot lose its independent doctors. We should be building products that will help these doctors flourish and connect them to the larger health systems and government agencies that are crucial in healthcare delivery.

The survival of independent medical practices is the key to ensuring the village includes everyone and that doctors and patients indeed will have freedom of choice.

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