Our Mission: High-Value Healthcare

by Gail Amundson, MD
Quality Quest for Health

Quality Quest for Health is on a mission to bring people together to create healthy communities with high-value healthcare.

Most people can picture a healthy community. In a healthy community, people lead healthy lives. Few people smoke. Responsible alcohol use is the norm. Waistlines are slimmer and people are active. Healthy communities stay fit together.

What does high-value healthcare mean?

High value means healthcare dollars buy more. High-value healthcare means patients get better service, results are better and efficiency improves. A high-value system provides health coverage to everyone. High-value healthcare has been an elusive goal.

Let’s step back and take a look at some facts for perspective. The U.S. spends more than twice as much as other developed countries. That should be enough to buy good results, great service and health coverage for everyone, but it doesn’t. Death rates are poorer than Cuba and Hungary. Our babies are twice as likely to die as babies in France and Germany. And we do not do better in Illinois. Illinois is one of the costliest states, with below-average quality results. Overall, we rank 36th in the country.

So what is wrong with this picture? Why don’t we do better? We spend a lot on healthcare—why don’t we get better value? We have well-trained clinicians—medicine attracts caring, bright people to its ranks. We have highly respected, mission-driven institutions in our communities. We are home to world-class companies.

Here’s the dilemma. What we want is health, efficiency and great service. But healthcare has no incentive to keep people healthy, few incentives to get better results and none to keep people out of the office, hospital, imaging centers or dialysis centers.

A big problem is how doctors and hospitals are paid. Fee-for-service means the more doctors and hospitals do, the more they make. Incentives work. We are getting what we pay for. Need them or not, patients get more tests and more procedures. With more tests and procedures come more mistakes, more misdiagnoses and untested therapies, and healthcare costs go up.

Another problem is how much we pay for different services. In the U.S., doing tests and procedures is far more remunerative than providing primary care. This is not true in other countries. An MRI in Japan, for example, costs less than $100 while in the U.S., the same MRI costs more than $1,200.

Primary care is in danger of dying as a specialty—just two percent of last year’s graduating medical school students chose primary care residencies. No wonder. Specialists, especially those who do procedures, make three to five times as much as primary care doctors, or more. Yet, experience from around the world tells us that primary care is the core of any efficient and effective healthcare system.

A third problem is thinking about healthcare costs and health coverage as separate issues. They are inextricably linked. Year after year, healthcare cost increases have outpaced inflation. Many employers, to remain competitive in a global economy, have been forced to trim coverage. Some can no longer afford to offer health insurance to their employees. So, the number of people without health coverage continues to swell. Costs and health coverage are two sides of the same coin. One cannot be solved without addressing the other.

National consensus is building that expanding healthcare coverage to everyone must be accompanied by aggressive efforts to bring down costs and reward quality care. A high-performance, 21st-century health system revolving around the central goal of paying for results will entail managing chronic conditions better, adopting electronic medical records, coordinating care, researching what treatments work best, realigning financial incentives to reward success, encouraging prevention, weeding out waste and saying “no” to expensive, unproven therapies.

Quality Quest for Health agrees, and we are not waiting for national solutions to solve the problem. We are working together to test a new way to pay for primary care in clinics that are re-engineering themselves to provide high quality, efficient care focused on great service and good results for every individual patient. Our Patient-Centered Medical Home team, led by Dr. Dean Gravlin, spent 2008 planning and is preparing to pilot at four to six primary care clinics in our region in 2009.

Transparency—publicly reporting results—is an essential ingredient in a high-value healthcare system. Quest began reporting generic prescribing rates of local clinics last year. Prescription medicines can be very expensive. Prescribing the most affordable medications adds value. Our second quarterly report was posted to our website (QualityQuestforHealth.com) in December.

Soon, we expect to begin reporting a second measure, high-quality colonoscopy. Our 2007 Colonoscopy Quality team, led by Dr. Terry Baldwin, developed care standards and set up processes for gathering data and reporting results. High-quality colonoscopy focuses on ensuring the right people are getting the procedure, avoiding complications and recording essential information during the procedure. Stay posted.

Getting higher value may be a thorny problem, but it is not one we can ignore. Our health depends on us working together to create local solutions. Quality Quest for Health brings consumers, healthcare providers, employers and health plans together. Our goal is to transform healthcare—together. iBi

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