A Roadmap to Value in the American Health Care System
In February, the University of St. Thomas’ Health Care MBA and former Senator Dave Durenberger welcomed Guy Clifton, M.D., to campus to discuss his new book, Flatlined: Resuscitating American Medicine. Dr. Clifton is a neurosurgeon, clinical investigator, administrator and health policy advocate.
In his talk, Dr. Clifton highlighted some of the most pressing problems facing the health care industry and offered solutions to address them. (The video and PowerPoint of his presentation is here.) He identified the rising cost of health care as an urgent and underlying problem. At the current rates, Medicare will be insolvent by 2050 and the federal government will be facing a major tax problem within the next eight years. It is crucial to get health care costs down.
There are two ways to decrease costs: become efficient or cut prices. Dr. Clifton focused on what he calls a “roadmap to value,” which would increase quality in order to decrease cost. He identified three broad categories of unnecessary spending in health care: inefficient hospitals, poor management of chronic disease, and unnecessary procedures. Improving quality in these areas, he argued, would also decrease costs in the long run.
Dr. Clifton suggested three specific ways to achieve decreased costs by increasing quality:
• Anchor yourself to one primary care doctor of your choice
• Pay providers for the quality, not the quantity, of their care
• Establish, measure and report benchmarks of quality medical practice
Dr. Clifton stressed the need for benchmarks to standardize medical practice. The first step is to determine best practices. The second is to establish benchmarks of quality: Who needs to see a specialist? Who needs to be hospitalized? Which diagnostic workups are appropriate? He argued that we can no longer have such large populations being treated with massive variations in care. We need to establish benchmarks and offer doctors malpractice protection for following these standards.
Dr. Clifton estimates that hospital inefficiency accounts for 15-40 percent of hospital spending. When patients are admitted to a hospital for a procedure, costs are almost double if they experience complications. As an example of how benchmarks of quality can help reduce costs, Dr. Clifton described how the LDS Hospital in Salt Lake City, Utah, was able to reduce the hospital-acquired pneumonia rate. The nurses in the critical care unit designed a protocol to monitor and control blood glucose levels in patients. As a result, they had a four-fold decrease in the pneumonia rate and, ultimately, reduced their costs as well.
Another large source of unnecessary spending, according to Dr. Clifton, is poor management of chronic illness. The medical home can be an effective way to treat patients with chronic disease and reduce overall costs. The LivingWell clinic in Gallatin, Tenn., is an example of how quality primary care can result in decreased costs. At this clinic, 12 general internists collaborated to treat 1,400 Medicare Advantage patients. The insurance company agreed to pay a 30 percent bonus if they hit the 90th percentile for quality and reduced the cost of care. The keys to their success were being the first point of contact for the patients, spending more time with each patient, being available to the patients 24/7, practicing standardized management and monitoring quality. At the end of two years, the doctors in this clinic had not only improved quality but also had savings of 20 percent.
Throughout his presentation, Dr. Clifton stressed the need for immediate action to reduce health care costs by improving quality. He argued that improving efficiency and quality is the best means to reduce health care costs. This can be achieved by focusing on primary care, paying providers for quality not quantity and establishing benchmarks for quality care.