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Investing in and rebuilding primary health care and building human-centric health plans are critical to addressing rising health costs and the opioid addiction epidemic, according to Health Rosetta co-founder Dave Chase, who addressed local officials at the annual MIIA luncheon held during the MMA Annual Meeting on Jan. 19.
The author of “CEO’s Guide to Restoring the American Dream” and “The Opioid Crisis Wake-Up Call,” Chase used an image in his presentation of a Mr. Potato Head toy with all the parts put in the wrong places.
“In many ways, our health plans are like this misshapen Mr. Potato Head – they kind of have all the pieces, but they really don’t work well together,” Chase said.
For example, instead of rebuilding a devastated primary care system, health plans use various “Band-Aids” to cover up the deficiency, from primary care occurring in hospital emergency departments to urgent care clinics, retail clinics and nurse care coordinators.
Meanwhile, cities like Phoenix, Denver, Seattle and Tyler, Texas, are taking thoughtful approaches to rebuilding primary care in their health plans, recognizing that the same pieces can be put together in different ways to best serve the insured.
The state of the primary care system in the United States is the “one thing that has created more fertile ground than anything” for the opioid crisis, Chase added. He said today’s model is designed to get patients in and out to higher margin care – one reason why the U.S. has prescription rates five times higher than most countries.
It’s telling, he said, that lower back pain is the number one driver of disability and the number one driver of opioid prescriptions. Chase applauded MIIA for its pilot program that launched on Jan. 1 with Integrated Mechanical Care that will use mechanical diagnosis and therapy to offer alternative treatments for musculoskeletal issues like lower back pain.
“This [epidemic] is entirely a self-inflicted wound by our health care system,” he said. “I studied this crisis, and it became clear it wasn’t an anomaly. It is our health care system.”
Chase added that prescriptions for benzodiazepines today, generally for treating anxiety, are where opioid prescriptions were 10 years ago.
“Unfortunately, most of the government and media commentary and response has been treating the opioid crisis like it’s an anomaly, and we will be right back there on ‘benzos’ if we continue,” he said.
Chase opened his presentation with a classic image from the Great Depression, noting that one definition of depression is two or more years of income decline or stagnation.
“By that definition, the working and middle class in America is in a 20-year long economic depression – not because employers aren’t spending a lot more money; the problem is that every dollar has gone to health care,” he said.
The pursuit of affordable and effective health care is a personal one for Chase. After starting his career in revenue cycle management, tracking patient billing from initial entry to the health care system to the final payment, by his late 30s Chase had watched 10 friends his age or younger die. The last one hit him the hardest: A woman who had been successful in her career and should have had access to excellent health care, but was misdiagnosed, leading to a treatment plan that devastated her medically, financially and emotionally. She left behind a 10-year-old daughter.
“What really hit hard was that I realized I had been part of that system,” Chase said. “The way I was raised, if you see a problem and you don’t do something about it, you’re complicit.
“At one time, [revenue cycle management] was a reasonable thing. … Unfortunately it’s become the root cause of something that’s very arbitrary, abusive and extractive to the working and middle class, and really the entire country.”
The United States is the “undisputed” world leader in medical bill-driven bankruptcy, he said, but in 70 percent of these cases, the person had insurance.
“The calvary is not coming from D.C.,” he said. “This is on us to fix this.”