If you were able to attend our winter conference, you know we hit on themes at the very core of our work at the Quality Institute.
How can we improve quality and reduce costs? We all know it’s possible. And we all know it’s going to be really tough.
As our keynote speaker Niall Brennan said: “You can’t find a hospital CEO who will say, ‘I want my institution to be 25 percent smaller in ten years.’ If you did, he or she would be fired and replaced by a CEO who says, ‘We’re planning a $100 million capital expansion.’”
Brennan knows what he’s talking about. He’s former Chief Data Officer at the Centers for Medicare & Medicaid Services and is now President of the Health Care Cost Institute. He had a few other observations about reducing the 30 percent of waste in American health care.
“We can’t achieve true value-based health care and still have everybody win. That makes no sense. We can’t have true transformation and also have no losers,” he told our conference attendees.
Last week, the government announced that we now spend over $3.3 trillion on health care, or 17.9 percent of our GDP. Health care grew 4.3 percent in 2016, 1.5 percent faster than the growth in GDP.
We called our conference, Getting to Affordability – Is Data and Transparency the Answer? And I think we all agree the answer is yes. We need to measure how providers practice and what it costs. As Brennan said, “With data, you are a truth teller.”
Our conference also included an expert panel, including Michael Renzi, DO, FACP, Chief Medical Officer of Continuum Health. He was as candid as Brennan —especially about how incentives, such as shared savings, can drive quality.
“Quality can be lucrative,” he told those at our conference. “You say to a medical practice with high per capita costs, ‘Your practices are not in line with your peers.’ Not much happens. Then you start talking money. You show them where the waste is, where they don’t measure up, and how it impacts their reimbursement and bottom-line. Now, we have engagement.”
But as we also discussed, reducing costs does not mean rationing care. It’s about transforming how we deliver care. Insurers are playing a role, as Mary Ann Christopher, MSN, RN, FAAN, explained at our conference. She is Vice President, Clinical Operations & Transformation at Horizon Blue Cross Blue Shield of New Jersey.
She described a 49-year-old liver transplant patient who was in and out of the hospital three times each month. Data collection brought the case to the attention of Horizon, which reached out to the patient and learned his pain was not properly managed. He received palliative care and other medical support. He was able to return to his job and his depression over his pain and inability to work lifted.
Better care costs less. Christopher mentioned a teenager with repeated trips to the ER for suicide attempts who was released with a prescription to follow up with a psychiatrist. The appointments were often weeks away. “We got her an immediate appointment. We got her family involved and she was able to return to school. This happened because we worked with data,” she said.
Our conference also included Stephen P. O’Mahony, MD, FACP, Vice President and Chief Medical Information Officer at RWJ Barnabas Health. He noted the data must be easy for providers to use. “There may be data about the best antibiotic to prescribe for specific patients and the lowest cost antibiotics. But imagine looking for that data 30 times a day? The data has to be at the fingertips of the provider.”
He also mentioned a colleague who lost money by spending an hour and a half getting a patient into palliative care. “We also need to reduce the barriers to making the right decision for patients,” he said.
Niall’s presentation is available on our website.
As this year closes, I wish you all happy holidays and look forward to continuing our work together in 2018 on Getting to Affordability. I know we have both challenges and opportunities ahead.