Since the federal government began pushing outcome-based medicine in the runup to the approval of the Affordable Care Act (ACA), the healthcare industry has been attempting to fulfill the goal through something known as ‘complete care’. In theory, complete care is collaborative and proactive.
I say ‘in theory’ because my own experiences do not line up with the precepts of complete care. And guess what? I am not alone. Despite the theoretical benefits of complete care, and studies allegedly showing that complete care works, its practical realities are far different. Your own experiences might even tell you this.
What Complete Care Actually Is
Complete care is more of a delivery philosophy than an actual science. Providing complete care means delivering healthcare services in a collaborative environment centered on the patient’s needs. When done well, complete care is coordinated care that provides for the physical, mental, social, and spiritual needs of patients.
Utah’s KindlyMD says that proactivity is one of the hallmarks of complete care. In other words, rather than merely reacting after a patient injures himself or develops some sort of medical condition, complete care seeks to maintain good health for as long as possible. It seeks to avoid preventable injuries, diseases, and maladies.
This is all well and good, but the American healthcare system isn’t really run by primary care doctors, specialists, and hospitals. The system is run by private insurance companies whose main goal is to drive profit. And as the healthcare system is gradually consolidated under a small number of continually growing healthcare groups, profits are also being concentrated. The end result is that profit takes precedence over actual care.
Improving Patient Outcomes
Kaiser Permanente began implementing its own complete care program decades ago. In 2013, they issued a report claiming that “Complete Care, a collaborative approach to meeting patient needs, is improving outcomes for Kaiser Permanente patients.” The report went on to claim that Kaiser Permanente has developed rare disease programs and facilitated management of most conditions via outpatient care.
Let us give Kaiser Permanente the benefit of the doubt and assume that their complete care model works for them. What they have been able to achieve is not the norm. All over this country, patients are barely receiving the medical treatments they need because they cannot keep up with a system built to be reactive and complicated.
I personally know a man who injured his back more than three months ago. Just days before his back injury, he had undergone knee replacement surgery. While his knee has healed up nicely, his back injury remains. Pain medication has not helped. All he wants at this point is access to an injection therapy to alleviate his pain. But it is a no-go without a physician’s referral.
This poor man has been shuffled from one doctor to the next. Every doctor tells him the same thing: “Take these pills and come back and see me in a couple of weeks.” This is not complete care. This is not collaborative or proactive.
Some Are Doing It Right
In fairness, there are some in the medical community doing it right. Private clinics and primary care offices that do not take insurance are a good example. Since they are not controlled by insurance, they are able to offer genuine complete care that works.
When it works as designed, complete care succeeds in its collaborative and proactive approach. But complete care successes are not the norm. In reality, the practicalities of American medicine make complete care very difficult to offer on a consistent basis. We can thank the insurance industry for that.
