It will pay to sort through weeds on health reform

Over the years, the American health care system lost its way. Seduced by miraculous technology and pharmacology, and the billions of dollars that could be earned, our health care system geared up to perform miracles, mostly in the areas of traumatic injury or serious illness. The theme here is you get what you pay for, and as a result, today we can perform miracles for those who are seriously injured or ill.
Our health care system does not, however, do well at all regarding our overall population’s health, wellness, preventive care, chronic care and interventions. As a nation, we are becoming more and more unhealthy, and yet we use more and more health care resources, largely without lasting effect.
American health care quality ranks 37th in the world, trailing countries like Morocco, Costa Rica and Saudi Arabia. Deaths due to avoidable medical errors in the United States are roughly equivalent to a fully loaded Boeing 747 crashing every other day, all year, with all aboard perishing.
This should alarm business decision-makers who face tough health care choices in the coming years. Although CEOs are pulled in many directions and often don’t have the time to delve deeply into matters, this is the exception to the rule. Chief executives must understand the real causes of our broken health care system in order to navigate (and take advantage of) the changes mandated by Obamacare.
True health care reform requires the following:
1. To reform health care, we have to reform how we deliver it.
2. To reform the delivery of health care, we have to change how we pay for it.
3. To change how we pay for health care, we need agreed-upon measures of quality of care and outcomes.
4. To measure quality of care and outcomes, we need interoperable electronic medical records.
• Delivery. We must reform the fundamental delivery of health care. Otherwise, health care premiums are likely to continue to double every seven or so years while still delivering poor quality and outcomes. As a CEO, you can see that won’t work for your company, nor could your company get away delivering that kind of service to your customers.
Unfortunately, our current health care is delivered tribally, as hospitals operate with virtually no communication with primary-care physicians, surgeons and other specialists.
How should health care be delivered in the future? It starts by integrating today’s piecemeal system.
A coordinated, integrated health care system focused on (and paid for) good outcomes and quality of care will result in substantially less waste and fewer errors. In the most appropriate setting, a “quarterback” should oversee all care via a digital communication system that ties all caregivers together and makes the patient’s entire medical record available as and where needed. • Payment. Though our per capita health care expenditures far exceed that of any other country, our delivery system is wasteful, error ridden, and of poor quality. The culprit is our reimbursement system (called fee for service). For the most part, insurers, self-insureds, and the government pay for “things done.” The more “things done,” the more compensation. CEOs, you’d like that for your business wouldn’t you?
How does a primary-care doctor increase her income? By seeing more patients per day. Good for quantity and income, bad for quality. We pay the very best cardiac surgeon the same fee as the very worst. Go figure. There is no other profession that would stand for that.
But is it difficult to measure quality? Hardly so.
• Measures of care. Today, we have only a few agreed-upon measures of quality of care and almost none for outcomes. Yet, despite the naysayers, these can be measured. We must by whatever means possible establish these measures. We cannot let perfect be the enemy of good. Start slowly and build. For hospitals it might be surgical error, in-line infections and readmissions for a start. Those standards should be set by health care professionals, not insurers or governments. And soon. Otherwise someone else will set them, and physicians won’t like that one bit.
• How to measure and reward. Lastly, there is no possible way to measure quality of care and outcomes (and thus reward them) without interoperable electronic medical records.
So, CEOs, what do you have to do with all of this? You are not in the health care industry. Messy stuff. Yet you are a purchaser of such services. And it’s very, very important to your employees. You and your fellow businesses must demand this reform now, and become actively involved in its design. You too must become savvy purchasers of your employees’ health care coverage.
You can do well (the paybacks, the subject of the last in this series of articles) by doing good, which after all, is what CEOs are all about. •


Jim Purcell has been a trial attorney for 25 years, and served as chief operating offer and CEO of Blue Cross & Blue Shield of Rhode Island for 11 years. This is the second of a five-part package of Op-Eds he’ll offer on health care delivery and reform.

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