Health care experts examine top performing, low cost communities

Jul 22 2009

Talk about health care reform efforts has focused largely on all that is wrong with the current system. In contrast, an event Tuesday in Washington, D.C., examined best practices in ten top performing communities where they spend less and have better quality of care.

NPR reports: "The health care debate in Washington has basically deteriorated into a choice between raising taxes or cutting care. But 'that's wrong,' says Don Berwick of the Institute for Healthcare Improvement. 'There's a third way. It's redesign.' To try to prove his point, Berwick, along with health luminaries Elliott Fisher of the Dartmouth Medical School, Atul Gawande of Harvard and Mark McClellan of the Brookings Institution, brought doctors and hospital officials to Washington from 10 communities around the U.S. where health spending is lower than average and health care outcomes are better than average."

NPR notes: "But translating the success of those communities - which ranged from Portland, Maine, to Everett, Wash., to Sacramento, Calif. - won't be easy. ... An even larger problem is that while there is relative consensus that Medicare's current payment system encourages doctors and hospitals to provide too much of the wrong care, no one is quite sure how to revise it to encourage just the right amount of care. 'I guess the way I would put it is even if I was a benevolent dictator for a day, I wouldn't feel comfortable at this point, given the state of knowledge, completely overhauling the Medicare payment system,' said White House Budget Director Peter Orszag, who has been studying the issue for several years. That has led to a conundrum in lawmakers' efforts to try to achieve long-term savings in the health care system. They know that overhauling Medicare payments is a key means to achieving that goal. They also know that if they do it wrong, they could leave the health care system - and the patients it serves - worse off than it is now" (Rovner, 7/22).

Kaiser Health News reports on the same event in which local hospitals and doctors joined forces to improve care and restrain costs: "Communities across the country aren't waiting for Congress to take action to improve health care quality and contain costs. ... [Leaders from communities] that feature low-cost, high-quality health care met in Washington yesterday to exchange ideas at an event organized by the Institute for Healthcare Improvement, a nonprofit group based in Cambridge, Mass. ... The institute, working with The Dartmouth Institute, Harvard Medical School, the Brookings Institution and the Fannie Rippel Foundation, invited representatives from 10 high-performing communities to the conference. The communities were chosen by examining per capita Medicare costs and federal hospital performance data and patient satisfaction data. The communities that were invited weren't necessarily the Top 10 in the country, but they were among the best in the nation. The institute wanted a geographic distribution.

KHN reports: "In most of the communities, hospitals work closely with doctors. In addition, most of the health systems use electronic medical records to track patients and improve care, and encourage a culture of restraining spending, involving physicians in changing health care delivery systems and collaborating with competitors to help patients. All the communities were dominated by nonprofit health systems.

"While the session didn't focus on the congressional health proposals, most in attendance stressed the need to change the Medicare payment system from a fee-for-service system, under which providers are paid for individual tests, visits and procedures, to a system under which providers are paid for an entire episode of care or for all the needs of a population over time. Other common themes that emerged from the communities: Strong leadership, particularly from physicians, is needed to improve and standardize health care; Having a strong base of primary care doctors is important -- but coordinating care among all providers is even more important; To improve accountability, health care data are needed to measure the performance of providers and to share with purchasers of care and the public" (Galewitz, 7/22).

In related news, NPR reports that President Obama has been stressing the idea that overtreatment drives health care costs: "President Obama has promised to overhaul the nation's health-care system in a way that controls costs and expands insurance coverage. But critics say the legislation that's appeared so far would achieve only one of those goals." Critics stress that more needs to be done to control costs at the same time the White House tries to strengthen an independent council of medical experts to oversee Medicare payments and recommend cost-saving changes. NPR reports: "The White House argues that using an expert panel to recommend changes every year would provide flexibility to adjust to changing needs. It also allows the administration to promise health-care savings in the future, without having to detail just how those savings would be achieved" (Horsley, 7/21).

Meanwhile, National Journal published a glossary of potential offsets for the pay-for-performance system as lawmakers consider ways to pay for health reform (Plautz, 7/21).