Keeping just one newborn out of the neonatal intensive care unit (NICU) could bring joy to a family and save hundreds of thousands of dollars in health care costs. Despite calls for more prevention and ongoing debate about health care reform, the consensus is that the system is inefficient and expensive. Payers and providers are often mired in a bureaucracy that even insiders find difficult to navigate, let alone change.
Given the cost of care, health outcomes in the U.S. are disappointing at best and alarming at worst. Insurance carriers and PBMs are not graded on patient outcomes, meaning they get paid no matter what kind of job they do and regardless of patient outcomes. In my experience, however, they are not the "bad guy." They are playing by the rules, but the rules are broken.
Infant and maternal health offers a compelling case study. The infant mortality rate is on the rise in this country; in fact, it rose 3% last year – the largest increase in two decades, according to the Centers for Disease Control and Prevention. In addition, the U.S. infant mortality rate is consistently higher than in other industrialized countries, and there are major disparities by race and ethnicity.
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