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The Heavy Lifting of Health Reform
There's no way to cut spending in American health care without re-engineering how care is delivered. This is the heavy lifting of health reform that we haven't heard much about -- that is, re-imagining how health care can be delivered based on a strong foundation of primary care where every American has a medical home. From there, a person's continuum of care can be managed to exploit the most effective and most appropriate services for their case at the right time in the right place.
The approach is bolstered through electronic health records that store data and allow a patient's information to freely flow where care decisions are being made. This is the concept of data liquidity: digital health information that is based on standards that allow the bits and bytes to move where they need to for enhanced clinical decision-making. Over time, as many patients' data are aggregated in EHRs, evidence mounts that separate clinical wheat from chaff -- and then trustworthy cost-effectiveness decisions can be made that prevent costly, non-productive services and products to be used.
This is anathema to certain special interests: namely, specialty physicians and life sciences companies, who fear "rationing" or "rationalizing" services and products under a primary-care led system. The latest ad campaigns from every stakeholder association has begun to fracture health alliances as they have done whenever Congress gets down to the serious business of health reform.
The financial give-backs promised by hospitals, health plans and pharmaceutical companies are one-time spends which don't do much to change health delivery in favor of rewarding the best providers, products and services. That will require re-engineering -- true re-imagination of how great health care delivery could be in America.
By
Jane Sarasohn-Kahn
|
July 20, 2009; 11:20 AM ET
| Category:
Health Care Reform
,
Health costs
,
Primary Care
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Posted by: lensch | July 22, 2009 3:31 PM
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"There's no way to cut spending in American health care without re-engineering how care is delivered."
This is what private insurers want you to believe. In my youth, the car companies kept pointing to speeding and drunk driving to keep the spotlight away from the unsafe cars they were building. This situation is similar. It is certainly true that the big savings are in delivery, but there are substantial savings in the elimination of private insurance that should not be ignored.
We can save $400 Billion each and every year by simply passing to a system like Medicare for All (HR676). These savings come from the 20% - 25% overhead of private insurers and the outrageous compliance costs they impose on physicians and patients. In addition we can save another $100 Billion a year by cracking down on the huge sums spent by Big Pharma on marketing. This $500 Billion is more than enough to pay for the expansion of Medicare so we would need no additional sources of funds as all of the current proposals require.
While we know we need to change our delivery system and we have good ideas what changes we want, we have no idea how to get the medical professions to adopt the changes. Once we get a nation health care program, we will be in a much better position to gather data and put pressure on the participants to re-engineer the system. Every other country provides an example to show this works.