The Healthcare Imperative Lowering Costs and Improving Outcomes: Workshop Series Summary (2010) / Chapter Skim
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7 Strategies That Work
7 Strategies That Work
Pages 241-256
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From page 241... ...
These estimates focused on five broad areas: unnecessary services, inefficiently delivered services, excess administrative costs, prices that are too high, and missed prevention opportunities. Focusing on these estimates, Dana Goldman of RAND, Eric Jensen of McKinsey Global Institute, Jonathan S
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The panelists frequently converged in their comments, specifically highlighting the ideas of: dimensionalities, including the suggestions to additionally consider the nuances of identifying concrete examples of inefficiency, the varying components of pricing, the benefits of some administrative activities, and the application of such estimates to the reform process and clinical care; technical challenges, including limitations of the data and consideration of the circumstances of individual localities when implementing policy changes; and opportunities, including obesity as an area of underinvestment in prevention and the development of further refinements in the analytics that facilitate action by policy makers. Laying the groundwork for subsequent presentations with his keynote address for the second workshop, Glenn Steele, Jr., draws on his experience leading Geisinger Health System to provide real-life examples of effective strategies to bend the cost curve.
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Finally, he also discusses Germany's focus on care coordination for individuals with chronic conditions and their provider, payer and consumer incentives, which together have lead to decreasing rates of hospitalizations for this population. REVISITING "UNDERSTANDING THE TARGETS" Translating Estimates into Policy The commenters spoke of the opportunities in terms of the costs and potential savings discussed at the May workshop, as well as the very intuitive nature of many of the interventions discussed.
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The panelists further identified how some administrative activities are duplicative and redundant while others support safety initiatives, quality improvement efforts, and fraud prevention. Lacking financial pressure and inelastic demand, Reischauer identified these areas as potential policy targets to create stronger incentives for providers and payers to maximize their administrative efficiencies.
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STRATEGIES THAT WORK AND HOW TO GET THERE Glenn Steele, Jr., M.D., Ph.D. Geisinger Health System Over the past decade, the Geisinger Health System has been able to leverage its market share, its continuum of care, and its strong partnerships with payers and providers throughout Pennsylvania to innovate in ways that produce real cost savings and positive health outcomes among those consumers with the highest disease burdens.
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Here we sought to identify high-volume diagnosis-related groups, determine best practices, deliver evidence-based care, and create a global, single-fee payment system for acute episodic care. As defined by Pennsylvania Health Care Cost Containment Council (PHC4)
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But since the introduction of this project, costs have fallen even more. ProvenCare Chronic Disease Optimization Extending the lessons and innovation of our work with acute episodic care, Geisinger has also looked at optimizing care for chronic diseases, such as coronary vascular disease, diabetes, chronic kidney disease, and preventive care.
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Our community practice leadership and our insurance company, Geisinger Health Plan, together developed a program of a series of patientcentric aims: patient engagement, physician endorsement and oversight of the care continuum, individualized care plans, automated assessment and triage, and coordinated care. Geisinger's insurance company supported nurses who were embedded in our community practice sites.
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We believe that what has made this work so powerful is that it included non-Geisinger physicians as well as partners who do not have electronic health records. Anatomy Geisinger employs a continuum of care model that includes the full range of healthcare services from primary care to specialty and subspecialty care.
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Conclusion As we share these successes with the broader medical community and as the national conversation continues about reforming the healthcare delivery system, ProvenCare and Geisinger provide a useful lesson in the power of experimentation. What Geisinger has been able to do is to learn "on the fly." Within a short time we have found some programs and initiatives that appear to work well and others that need continued tinkering.
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Their varied approaches to healthcare system design and successful cost control should inform the United States as it faces its own challenges with cost containment. The United States spends over twice as much per capita and 50 percent more of its gross domestic product (GDP)
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The major difference in other countries is that the fee schedules are not weighted toward specialty medicine; in fact, in many northern European countries, the generalist physician is paid a higher income than the specialist. In the UK, for example, the generalist has control over access to the specialty physician and typically earns a higher income than the specialist.
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In summary, payment reforms in the areas of drug spending, specialty physician compensation, and hospital-care spending could yield significant savings if we replicate the cost controls found in other OECD countries. No-Fault Malpractice Insurance One of the major concerns of U.S.
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physicians and policy makers, they also have similar rates of litigation and similar levels of awards. On the other hand, New Zealand has adopted nofault malpractice insurance and has significantly lower rates of malpractice claims, lower and more consistent monetary awards, greater cooperation in identifying and fixing medical errors, and much lower legal expenses.
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adopting no-fault malpractice insurance, and (3) creating separate programs for people with multiple chronic conditions.
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The Healthcare imperative: Lowering costs and improving outcomes workshop, July 16-18, Washington, DC. The Commonwealth Fund.
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