Health Care Reform Made Simple

My name is John Ross and I have spent my entire 40 + year career in health care. Specifically, my background and experience is in developing and managing evidence planning, reimbursement applications, and health economics strategies for a number of fortune 500 health care technology businesses. In short, my job was to help the companies that I worked for to understand the health care market place from three important perspectives. The first was to answer the question; “What can we expect to be paid for the medical technologies we are developing and planning to market? The second question; “will the results and/or lower costs associated with the use of these medical technologies justify the payment level we think they deserve? Finally, what product development, marketing and sales strategies do we need to employ to insure that our future medical technologies are quickly accepted by hospitals, physicians, payers and patients? Obviously with such a focus I had to deal with Medicare (health insurance for folks over age 65 and the disabled), Medicaid (state-run insurance programs for the less fortunate) and commercial health insurance companies (the companies that insure and administer employer-based health insurance plans). I also spent a lot of time assessing the needs of physicians, hospitals and large integrated health care delivery networks that purchase and use a wide array of medical technologies.

From a funding standpoint I have seen America’s health care system go from almost “anything goes” to today’s increasing focus on cost and outcomes. Outcomes, is just another way of asking the question; “for the dollars we are spending nationally or on a particular patient’s disease or injury are we getting a good value in return? In other words, is the price of the drug, medical device, procedure, diagnostic or surgical intervention worth the cost in terms of better results and lower costs compared to how we would traditionally manage this patient’s condition?

 

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