HHS in the 21st Century Charting a New Course for a Healthier America (2009) / Chapter Skim
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4 Increase Effectiveness and Efficiency of theU.S. Health Care System
4 Increase Effectiveness and Efficiency of theU.S. Health Care System
Pages 87-104
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From page 87... ...
Although the majority of the committee supports the language of the recommendation, David Beier, J.D., Senior Vice President of Global Government and Corporate Affairs, Amgen; Kathleen Buto, M.P.A., Vice President, Health Policy, Johnson & Johnson; and Myrl Weinberg, C.A.E., President, National Health Council, did not agree with the majority's view and provided 87
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From page 88... ...
To facilitate collection of these data, the department should actively promote the universal adoption of electronic information capa bilities -- including health information exchange and electronic medical, personal health records -- for administrative and clinical purposes. HHS'S ROLE IN A VALUE-BASED SYSTEM Medicare and Medicaid exert powerful influence on the U.S.
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From page 89... ...
, which would establish a Center for Comparative Effectiveness Research within the Agency for Healthcare Research and Quality (AHRQ) ; and the Enhanced Health Care Value for All Act (H.R.
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From page 90... ...
. If all patients nationwide had the kind and intensity of care that patients receive in the least-intensive, most conservative settings (notably Mayo Clinic in Rochester, Minnesota, and Intermountain Healthcare in Salt Lake City)
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From page 91... ...
, based on data from CMS and AHRQ's National Healthcare Quality Report, 2005. Even in the nation's "best" hospitals -- those that are integrated academic medical centers and members of the Council of Teaching Hospitals and Health Systems -- costs of care vary markedly.
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From page 92... ...
92 HHS IN THE 21ST CENTURY 100,000 90,000 Medicare spending for hospitalizations and inpatient physician services per decedent 80,000 70,000 60,000 50,000 40,000 30,000 20,000 FIGURE 4-2 Medicare spending for hospitalizations and inpatient physician services per decedent in the last two years of life among patients with at least one of nine chronic conditions receiving most of their care from selected Council of Teaching Hospitals (COTHs) integrated academic medical centers (deaths occurring 2001–2005)
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From page 93... ...
The secretary should work with Congress to es tablish a capability for assessing the comparative value -- including clinical and cost-effectiveness -- of medical interventions and procedures, preven tive and treatment technologies, and methods of 4 The Centers for Medicare and Medicaid Services projects that by 2017, national health expenditures will double to more than $4 trillion annually. With the leading edge of the baby boom generation beginning to become eligible for Medicare in 2011, that program would more than double its 2006 size, to reach $884 billion, as would Medicaid, reaching a projected $402 billion.
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From page 94... ...
Although the majority of the committee supports the language of the recommendation, David Beier, J.D., Senior Vice President of Global Government and Corporate Affairs, Amgen; Kathleen Buto, M.P.A., Vice President, Health Policy, Johnson & Johnson; and Myrl Weinberg, C.A.E., President, National Health Council, did not agree with the majority's view and provided dissenting opinions, which can be found in Appendix F They were unable to agree on a common statement.
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From page 95... ...
. To this committee, research related to establishing value creates actionable information about the relative benefits and costs of preventive and treatment technologies, procedures, and methods of organizing, delivering, and paying for services.
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From page 96... ...
AHRQ is working closely with other units of HHS to fulfill the goals of HHS Secretary Leavitt's Value-Driven Health Care Initiative. This initiative requires federal agencies that administer or support health insurance programs to provide information on the cost and quality of health care and collaborate on strategies to do the following: • Connect data throughout the system, by adopting interoperable health information technologies and strategies.
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From page 97... ...
In such a potentially contentious arena, the analyses that support coverage decisions must be absolutely independent, methodologically sound, and perfectly transparent. Although information is rarely perfect and controversies may arise, in the long run it seems fundamental that payers should reward care for which there is evidence of value and discourage care that is either too costly for the benefit received or too low in benefit, regardless of cost.
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From page 98... ...
The department should collaborate with state and local public health agencies and community-based organizations, as both sources and users of prac tical program guidance. PUBLIC INFORMATION The era when Americans were passive recipients of health services and physicians were unquestioned authorities is fast fading -- in part because of societal trends and patients' own desires, influenced by new
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From page 99... ...
Outpatient surgery and faster hospital discharges send patients home needing significant attention and infection control; an increasing number of home care technologies -- heart disease monitoring, diabetes and asthma management, kidney dialysis, analgesia pumps, and many others -- require greater knowledge of both the disease and how to work with sophisticated equipment; home-based hospice teaches families to handle emergencies and to manage pain and symptoms; parents of children with severe disabilities learn to deal with respirators and feeding tubes, and to watch for early signs of impending crises. Families dealing with elderly members aging in place are presented with a constellation of care choices and decisions, sometimes having to be made for a loved one no longer capable of participating in healthrelated decisions.
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From page 100... ...
Extensive research has shown that involving patients effectively in decision making increases their knowledge of their choices, gives them a realistic understanding of what to expect, and helps them be comfortable with the choice made. For example, when patients were given appropriate help in deciding whether to have major elective surgery, about 25 percent fewer chose the more invasive surgical option, with no adverse effects on health outcomes or satisfaction with care.
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From page 101... ...
The use of health information technology can improve the continuity and integration of care the committee espouses, by facilitating exchanges of information when a patient is referred from one physician to another, goes to a different hospital, fills prescriptions at different pharmacies, seeks care while traveling, or obtains health-supporting services from social workers, mental health specialists, or other health care professionals. Such technology would make health care more accessible for patients if more physician offices allowed patients to schedule appointments and obtain test results online, send their physician e-mail queries, receive electronic reminders, and provide helpful clinical information.
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From page 102... ...
. Having available timely electronic data from both the public and the private sectors will enable the secretary to provide Congress and the American people with a more complete picture of the state of Americans' health, unmet needs, the costs and effectiveness of health
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From page 103... ...
To assess the health of the American people and overall health system performance accurately, the department needs current data from the nation's health system. To facilitate collection of these data, the department should actively promote the universal adoption of electronic information capa bilities -- including health information exchange and electronic medical, personal health records -- for administrative and clinical purposes.
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From page 104... ...
Health Affairs Suppl Web Exclusives: w96-w114. Wennberg, J., E
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