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Deborah Walker Keegan

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What a new healthcare-delivery system might look like

Deborah Walker Keegan, Ph.D., president of Medical Practice Dimensions Inc., discusses in Medical Economics how to restructure the U.S. healthcare-delivery system. Among her observations:

”Pharmacy and retail blockbuster chains, having already embarked on retail and express clinics, are now proposing partnerships with commercial insurers to expand their reach, improve their bottom line, and reposition themselves as the new ‘front door’ of primary care.”

She asks:

  • “Do we want to have pharmacy/insurer monoliths wield power to steer patients to specific facilities and providers for care, services and medications?  Beyond primary care, patients need access to specialty care and care coordination across the continuum of healthcare services. Except for the small number of proposed mergers that involve multispecialty provider groups … is this on the companies’ radar?  If so, what are their proposals for a comprehensive delivery system of care?
  • “Will we be fracturing an already dwindling provider supply?  It is doubtful that economies of scale will be realized by placing one or two clinicians in a retail pharmacy and replicating this model over tens of thousands of sites as they compete on every corner. Primary care clinicians may become an even more endangered species than they already are, with many seeing only a handful of patients per day.”


She says that an  innovative healthcare delivery system could look like some of the following:

  • “Patients living or working within a defined region receive care from a designated healthcare delivery system.
  • “Patients receive primary care services locally and specialty care services regionally. The most complex procedures are performed in a few, well-established centers of excellence located throughout the country.
  • “The regional healthcare delivery system is incented to improve and/or maintain population health and wellness; financial incentives and/or subsidies are paid to the systems themselves (rather than to patients or commercial insurers).
  • “Patients purchase health insurance directly from the regional healthcare delivery systems, thereby effectively integrating the financing and delivery of healthcare and thus aligning incentives.”

To read her whole essay, please hit this link. 



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