Tuesday, August 4, 2009

What #HealthReform will look like II

Cost and quality are intertwined and very important issues in any healthcare reform plan. With medical malpractice reform off the table, reducing costs will require administrative simplification and reimbursement changes. We will need to move from paying for volume to paying for quality. The implementation of a Medical Home Model can help with chronic disease management and provide better continuity of care, while also ultimately lowering costs. We should create increased incentives for health savings accounts, with a mix of public and private coverage available. Involving the patient as much as possible in healthcare decisions (and giving them a financial stake) will be an important component if reform is to be successful.

Attempts at administrative simplification (remember HIPAA) is no guarantee that costs will be lowered, but streamlining billing codes and practices can do a lot. We can save billions of dollars by cutting through the administrative red tape, according to a recent report released by the Healthcare Administrative Simplification Coalition, or HASC. Founded by the American Academy of Family Physicians, the American Health Information Management Association and the Medical Group Management Association, HASC is a partnership of organizations committed to reducing the administrative costs and complexity of health care. The report "Bringing Better Value: Recommendations to Address the Costs and Causes of Administrative Complexity in the Nation's Healthcare System," claims that about 25% of healthcare costs (approximately $2 trillion) go toward administrative functions, such as billing and payment tasks. "These wasted health care dollars could be much better spent on ensuring that all Americans have access to high-quality health care," said Douglas Henley, M.D. "If we don't work toward reducing administrative complexity in our health care system, we'll continue to waste both time and money."

The healthcare cost explosion has not been accompanied by clear and measurable quality improvements, and we are going to eventually need to change the way we pay for care. We should try to stop paying based on the number of procedures and instead pay based on results. Tying payments to outcomes not only saves money, but improves quality. Minnesota has implemented an innovative program called QCARE, for Quality Care and Rewarding Excellence. QCARE identifies quality measures, sets aggressive outcome targets for providers, makes comparable measures transparent to the public, and changes the payment system to reward quality rather than quantity. These types of innovations will be required on a national scale.

But cost reforms won’t help much if we don’t have more doctors working in the fields where we need them, such as primary care, pediatrics, and behavioral/mental health. Physician workforce enhancement programs will provide greater access, lower costs, and higher quality care. When doctors are not overloaded, stressed out and under-reimbursed thay will provide much better care.

Health information technology will also lower costs and improve quality. Most providers lack the information systems necessary to coordinate patient’s care, share necessary information, monitor compliance, and measure and improve performance. Most other industries have lowered costs and improved quality through investments in information technology, yet healthcare has been stuck. It is time to pull our healthcare system into the 21st century. Health IT helps with prevention by scanning patient records for risk factors and by recommending appropriate preventive services, such as vaccinations and screenings. Health IT can also assist in effective chronic disease management by helping to identify patients in need of tests or other services, and ensuring consistent recording of results. Patients using remote monitoring systems can transmit information directly from their homes to their providers, allowing a quick response to potential problems. I think that all of the efforts at reform are going to need to be tied to a robust national health information network.

I like the quote from President Franklin D. Roosevelt: “In regard to every problem that arises, there are counselors who say, ‘Do nothing’; other counselors who say, ‘Do everything.’ Common sense dictates an avoidance of both extremes. I say to you: ‘Do something’; and when you have done that something, if it works, do it some more; and if it does not work, then do something else.”