Tuesday, February 26, 2013

It’s Time to Transform Healthcare – and We in the Industry Know How To Do It

In his February 23, 2013 article in the New York Times, Richard Thaler, noted professor of Economics at the Booth School of Business at the University of Chicago, makes several suggestions on how to improve US health care.

Among them are:
  • Paying doctors and hospitals for health, not illness treatment
  • Using evidence-based medicine approaches
  • Making more efficient use of nurse practitioners, pharmacists, physician assistants and other medical professionals
  • Opening opportunities for all patients to have end of life discussions
  • Implementing safe harbor from medical liability under certain situations
  • Incremental changes and experiments with innovation to improve the US health care approach

These are all good ideas that have been under discussion, some for many years. I agree with the ideas, but I would argue in favor of reaching further, reaching for transformational changes. To amplify this thought:
  • The Affordable Care Act opens the door for Accountable Care Organizations (ACOs).  Well designed ACOs have the potential to transform US healthcare in many ways:
    • Payment reform is part of the ACOs model which requires moving away from fee for service payments, where doctors and hospitals get paid for providing more services, not delivering better health. The ACO promise is to pay based on quality of the outcome. This is not a new version of the HMOs of the 90’s, where doctors were often paid more for denying services – a lack of focus on improved quality that led to their demise.

    • Patient-centric care delivered by a medical team, led by the primary care physician but including all needed disciplines.  In a patient centered approach to diabetes care, for example, the medical team would include a physician, a certified diabetic educator (CDE) or nutritionist, psychological support and an exercise physiologist. This team, taking into account the needs and desires of the patient, works together with the patient to deliver exceptional outcomes. This saves money by decreasing the need for amputations, coronary artery bypass operations, and dialysis.

    • Supporting the medical evidence base by funding effectiveness research and the implementation of those findings into medical practice, much sooner than the current implementation average of 17 years, by some estimates.

  • End of Life discussions and planning are not “death panels,” and we cannot, and must not, get tangled up in arguments based on inaccurate assumptions as a way to avoid these needed discussions.
    • Patients want a peaceful and dignified death, with family present if possible

    • Doctors need to be trained on how to have these discussions with the patient and family and learn how to better understand the patient’s wishes at the end of life.

  • Medical liability reform
    • Very simply, doctors following the best course of actions using evidence-based medical decision making should not be sued. I would recommend safe harbor principles organized around following evidence-based guidelines, not by physician. Electronic health records can play a supporting role in this effort.
A healthcare system implies a uniform, defined approach to problem—something the US does not have. We have a fragmented, expensive sector not designed with the goal of improved health, but organized around principles where the main benefactor is the entire healthcare industry, not the patient. I don’t think we need more experiments; we need transformational change with the goal of achieving the Triple Aim of improving healthcare quality and satisfaction, improving population health, and reducing the cost of healthcare.

Dr Michael L Taylor
Chief Medical Officer

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