“[W]e really have a ‘sick care’ system, not a ‘health care’ system. It is not designed to help people manage chronic disease, prevent illness or support comprehensive well-being,” says 1199SEIU United Healthcare Workers East President George Gresham in the August 4 New York Observer. In Even a Health Care Union President Wants Less Patients in the Hospital, Gresham explains how New York State’s Delivery System Reform Incentive Payment (DSRIP) Program and other recent changes in state and federal health care law aim to reverse that trend.

DSRIP was designed to undo many of the out-of-balance financial incentives that have made our healthcare system the most expensive in the world while causing “premature deaths and unnecessary suffering, especially in low-income neighborhoods and communities of color,” Gresham writes. Citing examples like an asthmatic child “who doesn’t have the medication or the tools to manage her disease and so spends her weekends in the hospital instead of playing outside,” he points out that the default position of our fee-for-service system is to use pricey, sometimes painful procedures to treat the very sick and then send them home, often to the same conditions that caused the illness. “Sadly,” he says, “it is more lucrative for a health system to amputate the leg of a patient with uncontrolled diabetes than it is to help that person better manage their disease through outpatient coaching.”

But DSRIP is starting to change things by investing more in primary and preventive care. At the end of five years, Gresham says, New York’s Medicaid program has set a goal that 80 percent of payments will be “value-based,” investing in higher quality at lower cost. Nationwide, the Affordable Care Act is encouraging innovation in care delivery and Medicare is also setting a goal for value-based payment.

Gresham says the union is backing these changes even though they will likely mean fewer hospital jobs for 1199SEIU members. This is in part because jobs lost in hospitals may well be replaced by new positions in the fast-growing outpatient care sector, which is projected to add 670,000 jobs nationally by 2022. But the main reason, he writes, is that “it’s the right thing for the health of our families and our communities.”

Read Gresham’s op-ed.

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