US HEALTH CARE SYSTEM RESTORATION
KEY COMPONENTS TO AN EFFICIENT MEDICAL DELIVERY SYSTEM FOR
A HEALTHIER POPULATION
All iso n A Step he ns , ME d
* PO Box 3 35 59 5, N Las Vegas , NV 89 03 3 * Te l 70 2. 30 0. 02 87 * all iso nastep hens@gmail .com *
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US HEALTH CARE SYSTEM RESTORATION
K EY C O MPO N EN TS TO A N EFF IC I EN T ME DIC A L D ELIV ERY SYST EM FO R A
HEA LT HIE R P O P U LA TIO N
SUMMARY
The US Senate and House of Representatives along with the Obama Administration are
taking on the task of reforming the US Health Care System. Corporate/private and academic
analyses of the current system and proposed reform measures are critical to this process. Yet,
each of these organizations has its own objectives, whether financial or ideological in nature.
This report is a straightforward list of actions to take in order to restore the existing US
Health Care System. It is not presented on the behalf of any company, organization, political
affiliation or socio-academic ideology. This is a request from an American who happens to
work in the health care industry and whose life has been altered permanently due to sickness
and a flawed medical delivery system.
KEY ACTIONS TO TAKE TO RESTORE OUR SYSTEM
• Incorporate comprehensive chronic disease management. A
comprehensive approach to disease management has six key components: (1)
traditional disease management, (2) patient navigation, (3) patient care coordination,
(4) clinical consultation, (5) 24/7 advice nurse hotline, (6) online medical record
access and (7) web-based self management tools like social networking (disease-
based communities, blogs, etc.), disease/lifestyle-related tutorials possibly including
24/7 nurse advice chat and (8) expand breadth of diseases included in disease
management programs.
• Standardize medical practice, while ensuring that individual needs are
met. More effective use of evidence-based medicine leading better acute disease
management, inadvertently decreasing litigation. Currently, evidence-based
medicine means that clinicians rely on biostatistical/epidemiological data to
determine how to treat patients. When a patient presents, the doctor treats for the
most probably ailment and only reevaluates this if a patient persists. Meanwhile, the
true disease process could be progressing. A more effective application of evidence-
based medicine would require clinicians to perform diagnostic tests/procedures if
signs/symptoms are not relieved within a given period based on the natural history
of the originally diagnosed disease. This would facilitate early detection for people
with more serious or less common diseases.
All iso n A Step he ns , ME d
* PO Box 3 35 59 5, N Las Vegas , NV 89 03 3 * Te l 70 2. 30 0. 02 87 * all iso nastep hens@gmail .com *
h ttp: //w ww. linke di n. co m/i n/ al li sonas te ph ens

• Mandate that providers using signs-symptoms- diseases software to
guide the diagnosis process.
• Make divorce-of-care more difficult for providers whose patients have
limited access to another provider. Patients who get into a verbal altercation
or whose actions are considered to be inappropriate can be divorced by an office.
There is little recourse for a patient who may have had a valid complaint or was
treated poorly by a clinician or a clinician’s staff. Often, people in rural areas or areas
with limited specialists are left without care because insurance companies make it
easy for clinicians to discontinue services to certain patients.
• Offer a Palliative Care option at <12 months prognosis. This will decrease
costs for highest medical expenses of heroic measures at end-of-life.
• Offer a Hospice Care option at <6 months prognosis. This will decrease
costs for highest medical expenses of heroic measures at end-of-life.
• Close loopholes that allow private insurance to punish their members
who choose hospice. Individuals who use hospice can choose to seek treatment
for non-hospice-related diagnoses such as Diabetes. Patients may choose to do this to
manage symptoms such as chronic thirst or blurry vision, etc. Currently, many
managed care Medicare programs suspend a person's coverage when they elect to use
their Medicare Hospice Benefit. On the other hand, Medicare considers the person
to have private insurance. So, the patient either has expensive medical bills or goes
without the treatment/care to which they are entitled.
• Increase NIH research funding, enforcing strict evaluation methods
within grant proposal requirements. Research helps the economy not only
through job production, but through the increased productivity of a healthy
population.
• Expansion of corporate and public wellness programs. Corporate wellness
plans should be in a benefits structure. Increased funding to the CDC is critical for
effective wellness and disease prevention programming throughout the country.
• Stop excluding oral and vision health from the discussion of health
care reform. Oral and vision health are linked directly to overall physical health.
There is a well-established correlation between expanding the role of dental
hygienists and helping people in rural areas to access basic dental care, which
reduces costs overall. Basic oral and vision services should be covered for Medicaid
members.
• Create regional consumer health advocate offices. Consumers need experts
to be able to navigate the health care system. Health care consumer advocate services
should include: (1) addressing balance-billing issues, (2) coordinating of benefits
between primary and secondary insurance carriers, HSAs, HRAs, FSAs, etc., (3)
guiding people through the insurance appeals processes and (4) negotiating provider
rates for non-covered services.
• Open up senior-only services to people with disabilities. There is a
national focus on the aged rather than people who legitimately need assistance. The
Restored US Health Care System should enable people with disabilities to be as
independent as possible.
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• Include behavioral health in the overall US Health Care System. No
longer can this be separated and ostracized as non-medical. The integration of
behavioral health into the traditional health care system will create better chronic
disease management and serve to decrease other public health issues such as
addiction.
• Tax employer-paid health benefits. Although this will generate funds to pay
for the health care reform process, it may not be as expensive at the individual level
because the larger risk-pool could even the distribution of costs.
• Integrate the payer and the provider. Partially-integrated systems, not
including hospitals, create a continuum within which the US Health Care System
can operate. Currently, payers and providers generally work at-odds, leaving the
patient caught in-between. Companies such as Kaiser Permanente and
UnitedHealthcare Nevada have demonstrated that a partially-integrated system can
be efficient and successful.
• Evaluate environmental exposures along with meteorological analysis.
This issue often relates to health disparities as certain populations may be exposed to
environmental hazards disproportionately.
• Enact health communications programming that targets specific
populations impacted by health disparities. Restoring the overall system is
not sufficient in making sure that all sectors of America receive necessary health care
and participate in preventive measures. There are many resources available to reach
populations that are disproportionately impacted by disease. Businesses use these
tactics in marketing; it’s time to use those same strategies to eliminate health
disparities.
• Expand the Medical Reserve Corps by creating a true grassroots
network where participants are incentivized for participation. This
grassroots network should be modeled from an issue-based campaign model of direct
action organization.
• Mandate Electronic Medical Records. This should include some universal
formatting including scanned digital imaging for providers and patients to access
easily, even with different software packages.
• Fund the development of innovative health care software. Develop
software to search for medical errors or conflicting information within an Electronic
Medical Record. Go paperless.
• Establish a single, universal medical identifier. This should be similar to
the National Provider Identifier so that providers and patients can access records
more cohesively.
• Enact simple ways for individuals to have their medical records
corrected. All too often a patient with misinformation on his/her medical record is
unable to have this removed or corrected.
• Subsidize medical liability insurance. The rising costs are making it
increasingly difficult for people, especially in rural or deeply urban areas, to find
doctors in high-risk specialties.
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• Standardized credentialing criteria nationwide. People should have some
assurance that the clinicians they visit are reputable.
• Open more open pharmaceutical negotiations and subsidize more of
the pharmaceutical research and development. This way, less R&D is
calculated in the costs of drugs once approved by the FDA.
• Increase FDA funding and reorganize the approval process for new
pharmaceutical products and medical devices. People need access to the
most current and innovative medical advances while still being safe. This especially
applies to those with terminal diseases.
• Honor our Veterans. Once we restore the overall US Health Care System, let’s
bring dignity back to the lives of our veterans. Restoring the Veterans
Administration Health System must be next on the list of our national priorities.
PRACTICAL APPLICATION FOR CONGRESS
One critical piece of open government that is by the people and for the people means that
legislators are trying to become experts on every facet of every legislative issue. Right now,
each health policy-designated staff person is gathering data from all types of sources in order
to enable members to make the best decisions with regards to this restoration agenda.
Only ordinary citizens/constituents have true on-the-ground information. All members
and their staff should ask ordinary people who live and/or work within the constraints of the
current US Health Care System specific questions about how to improve health care. The
proposed town hall meetings are one effective way of accomplishing this. However, please
note that the same interest groups on Capitol Hill are organizing groups of their employees or
sympathizers to dominate these forums.
It takes the input of people without titles to give real dimension to how policies will
impact people in the real-world. Step out of the traditional box and get foot-soldiers together,
asking nurses on hospital floors, patients recently discharged from hospitals, disabled people
using public transportation, research scientists, HMO professionals and people who rely on
their employer for health insurance coverage. Every American has a story when it comes to
our flawed system of medical service delivery; those stories must be taken into account at this
critical moment. Distractions of hot-button issues and fear tactics have no place in restoring
the health of the American people.
GETTING THE PEOPLE’S PERSPECTIVE
If there is an specific information that your office needs in response to this or any other
health care reform policy paper, please use the contact information provided in the footnote
of the cover page of this document. As a concerned citizen, I am offering my perspective on
the direction of health policy at this important juncture in the process of redefining American
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rights, privileges and the role of Capitalism in relationship to Public Health. I am doing my
part to participate in the restoration of our system.
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