The discussion on health care continues to be remarkably silent on the issue of creating better value.How do we know a federal insurance plan is going to provide better value to patients? Nothing in the proposed legislation ensures that it will.
It is a sad fact that instead of being able to talk about true health reform we have reverted back to partisan politics and attacks from both the democratic and republican side. As soon as the Mayo clinic pronounces the congressional bills are flawed the republicans jump all over the statement and use it to leverage their position.As soon as the Congressional Budget Office back tracks on their statement that neither Congressional bill would lead to a budget neutral health care spend over the next 10 years the democrats tout their work as "see we're doing the right thing".
So far no one is doing the right thing and it is beginning to frustrate all of us. As we've written before, the only way we will pay for full coverage for Americans is to take the waste out of the present delivery of care.The only way we do that is to have government and commercial insurers pay for health outcomes rather than volume but that means the providers and payers have to change.
Change is hard but some of us are changing and we know it's possible. We have great examples on the provider side of change.Take Group Health of Puget Sound who delivers a PMPM premium that is 15% below their nearest competitor. Or the University of Michigan in Ann Arbor who has delivered care for seniors at 4% less when compared to their peers year over year. Gunderson Lutheran's work on end of life care has resulted in the medicare costs being half of the national average.At ThedaCare the redesigned inpatient care process called Collaborative Care has delivered a 25% reduction in cost with improved quality. In almost all these examples delivering better value has led to lower reimbursement. These penalties are what need to be removed in any health care reform bill yet nothing yet exists in any proposal that would change reimbursement or care delivery.
More than 80% of the money spent on health care in the U.S. is spent on care delivery.Only 7% on health insurance administration. The answer to cost and quality is not insurance products. It makes sense for all Americans to have basic health plan coverage but this alone will only take a 2.3 trillion dollar problem to a 3.3 trillion dollar one.If we don't change care delivery and the way we pay for it insurance for all will make little difference in the overall problem facing America.
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