Health Care Reform is About Improving System Performance

I was asked to contribute to the sequel to the award-winning book, Paper Kills.  The New Edition (released just last week)  is called Paper Kills 2.0, How Health IT Can Help Save Your Life And Your Money .   In the Book, Newt Gingrich, Tom Daschle, and other national industry leaders explore the leading information technologies that can and will transform our health system.  I was pleased with how our chapter turned out -- it's the first chapter of the book and is called 'Re-charting Healthcare:  Innovations to Drive a New Delivery Model for Tomorrow's Health System'.

As part of the launch of the book, I was asked to comment on last's week Health Summit with other folks who spend just as much -- if not more time -- thinking about health reform.  My post -- Health Care Reform is About Improving System Performance is below. 

Health Care Reform is About Improving System Performance

I commend the Administration for continuing to try to keep healthcare reform in the spotlight -- it affects all of us in so many ways, and we all have to keep trying. The President kicked off today’s summit with a great summary of what’s happened with reform over the past year -- lots of people on both sides of the aisle have worked hard with good intentions, but somehow the whole effort/discussion/debate turned into an ideological and partisan battle in which politics seem to have trumped common sense.

What we need now is to take the opportunity to get back to a ‘common sense’ approach and get to the ‘basics’ of what we want reform to do and then figure out the best way to achieve those desired outcomes.

Everyone (citizens and politicians) wants more and better 'health' -- a better health delivery system, more prevention, more therapies to cure complex diseases, more and better doctors. In addition, there seems to be a large focus on ensuring that everyone has access to health insurance. But more 'health' is not free, and more health insurance does not necessarily equal more 'health’. Our challenge is to reduce the waste in our current system to get more 'health' for the same amount of money . This is clearly very hard, from both a legislative and practical implementation perspective, but it needs to be done.

If we look at today’s system performance, in our best case scenario (Breast Cancer), we’re only ‘getting it right’ approximately 85% of the time , and at a cost that will bankrupt our nation. We have massive variation in practices, costs and outcomes – at the root of which is a fee-for-service payment model that has locked us into the past inhibiting the kind of broad-scale innovation that has transformed nearly every other industry that touches our lives. If any other business were to run this way, common sense would tell us that it would fail -- people would lose their jobs and consumers wouldn’t get their products.

With healthcare, it’s more serious. When the system fails, people die . We can and need to do better. We need to create a new system -- transitioning healthcare from unmanaged care (show up when you are sick, fee for service) to informed, coordinated care (population focus and pay for outcome), and from unmanaged processes (treat in office/hospital, based on physician) to managed processes (assuring that patients follow a care pathway; drug and test regimen across time and location). To do this, we must:

· Take the Variation Out of Care By Creating Feedback Loops. If we do a task differently every time, we won’t be able to improve the result. In health, this is about using data to see what works or not, and then educating medical professionals and consumers pervasively to put the best methods into practice.

· Encourage and Stimulate Supply-Side Innovation. Our current fee-for-service payment model does not reinforce and reward provider innovation nor does it facilitate new industry entrants to drive better, more efficient, convenient, and cost-effective delivery methods. The current model rewards ‘doing more’ versus ‘doing better’.

· Shift the Value Chain. We need to let consumers and other health professionals like nurse practitioners or even software do some of the work that the most educated (and therefore, most costly) physicians should not and cannot be doing anymore. Physicians should be focused on using their unique expertise and skills on the things that require very specialized knowledge and skills like treating top priority, chronic diseases

Just making the system bigger -- adding more people -- doesn’t solve the problem. We have to change the health delivery system -- real reform is about ‘doing health’ differently. Once we figure out how to reform the health delivery system -- to get the most out of it, then we can turn our sights on how to design the right insurance programs and regulations to expand access. Regardless of how we do that, one point is clear –we need to decouple health insurance from employment so that it’s portable and open to all.  

Today’s discussion focused on four main areas -- controlling costs, reforming insurance, expanding coverage, and reducing the federal deficit. At the end of the day though, we won’t be able to tackle these issues until we fundamentally change the system -- how care is delivered and individuals manage their own health.