We believe there are three fundamental principles inherent in our current health care delivery model that has resulted in the health care crisis we are experiencing today.

The system rewards providers for the quantity, not quality, of care delivered. This allows providers the ability to offset the negative financial impact caused by reduced reimbursement rates and uncompensated care. Protection from malpractice claims is another motivating factor for providers performing/ordering unnecessary exams and procedures. “To avoid predatory lawsuits, surveyed physicians admit to adjusting their behavior to minimize their risk. Nearly 80% of doctors say they have ordered unnecessary tests and 74% say they make unnecessary referrals to specialist”

Patients are not accountable to adhere to their treatment plans. Patients are expected to self-manage chronic conditions and rarely comply with the prescribed plan. Poor adherence to treatment protocols remains a major factor in the advancement of chronic disease to a more acute and costly stage. Consider for example, on average, patients prescribed lipid lowering drugs remained without filled prescriptions for over one-third of the year. In fact, only about half of the patients are still taking the prescribed lipid-lowering medication six months after they are given a prescription, and only 30-40% are taking them after 12 months.

Providers are not held accountable for the quality of care they deliver. Despite the rhetoric from insurance companies and the government regarding “pay for performance” initiatives, implementation challenges will dilute the impact to a negligible level.

Providers are paid to treat medical conditions. They are not paid to keep people healthy. For the providers in the current healthcare delivery model, improving the health of a population through preventive measures is bad for business. So long as this fundamental principle exists, substantial amounts of money will be spent on physician and hospital services that are avoidable.