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BACK
What should we do to accelerate this transformation?
- First, help physicians and hospitals recognize that they already function in systems of care that are currently unaccountable. Elliott Fisher, MD, MPH, at the Dartmouth Institute for Health Policy and Clinical Practice has studied care patterns nationally. He finds that 75% of Medicare benefi- ciaries receive their care from definable aggregations of hospitals and physicians who practice together. Requiring some physicians to declare a more formal affiliation with their local hospital will create measurable units with which to evaluate and establish standards for cost and quality.
- Second, aggregate data across all payers to measure differences between unaccountable care organizations (UCOs) carefully and meaningfully. By aggregating all data, one stands a better chance of getting a statistical result that actually indicates a differencein practice pattern. These differences can then be reported back to the UCOs so they can investigate and correct the root causes. (Process improvement methods might be new to some systems, and they may require some technical assistance.)
- Third, begin paying for care on a predetermined, bundled basis. By paying for a whole episode of care, or a year’s worth of care for a chronically ill individual, one removes the incentive to do more to get more payment. This in turn creates a market for efficiency rather than the existing market for inefficiency. This is the beginning of living on a budget, which is what most other industries do to provide value, and what most other national health care systems do around the world. What we need to make health care sustainable for the state is for every Colorado care system to live on a budget.
The best system I know of in Colorado is in Grand Junction. Thirty years ago, geography conspired to make plain to the community's residents that they are dependent on each other to keep themselves healthy. They started Rocky Mountain HMO to give themselves a payment mechanism, and began organizing their care around primary care, not hospital or specialty care. Studies then and now show primary care is much more cost-effective than specialty and hospital care. They set budgets, designed systems to get the most out of the money they spent and set a goal that everyone in the valley should have access to care. Today, Grand Junction is recognized as the most efficient and effective region in the country for Medicare beneficiaries. Their costs are two-thirds of the national average, and they get better outcomes, including patient satisfaction. |
"THE BEST MEDICAL SYSTEMS
ARE THOSE THAT BEHAVE
as communities, not as individuals. They cooperate with one another, they are stewards of common resources and they problem-solve together to serve common goals including cost, quality and patient satisfactiion."
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Can all Colorado communities become like Grand Junction? The jury is still out, but by doing the things I suggest above, I think we stand the best chance of changing the way providers win: from doing more, to doing exactly the right thing at exactly the right time. That, I believe, would produce access to care that is accountable, high-value and sustainable. |
