COST: The Return of the Curve Benders

We realize that a lot of Americans are still confused by the Gumby-esque phrase "bending the cost curve."  They probably don't even see a curve.They see a straight  line going up and up and up. Or maybe a hole getting deeper and deeper and deeper.  (Wait until they see what insurance is going to cost next year -- two recent industry reports forecast 10 percent hikes at a time when a lot of us have less money to spend.)

A few new reports and articles take another stab at explaining what curve-bending means, and how to achieve it. Bending the curve means that health spending will keep growing -- but not as fast as it would without reform. We'll spend more as our population grows and ages -- but we'll spend smarter and slower.

NPR began a two-part series, reminding us that doctors get paid for doing lots of stuff to us, a perverse incentive that rewards volume over quality of care. The piece also asks whether the pending health reform legislation does enough to change how we deliver and finance care. It quoted Rep. Jim Cooper (D-TN),

The message of our medical system has been to 'sell, sell, sell, buy, buy, buy,' " Cooper says. "And the real message should be, 'What's really going to help me live longer and healthier?' "

"I liken fee-for-service medicine to the situation if we paid lawyers by the word, or by the paragraph," he says. "We would have the longest legal documents in the world, and essentially, that's what we do with our doctors, but most of us don't realize it."

 

 

 

Over at the Washington Times (where the editorial page has not been waxing enthusiastic about health reform,) op-ed contributor Dr. Sam Nussbaum, chief medical officer for Wellpoint,  strikes a similar theme. Who are the villains in health care? he asks. All of us who collectively "overgraze" on the commons of health care, he answers.

Physicians provide too many services, at least 30 percent of which do not improve health. Twenty percent of hospital patients are readmitted within 30 days of discharge, and pharmaceutical companies challenge generic medications that perform equally well at a fraction of the price. Health plans don't provide clear information on the quality and cost of physicians and hospitals. Our Medicare and Medicaid programs lack the political will to adopt the best approaches to improving quality while lowering costs. And our federal, state and local governments have failed to address costly new public health epidemics such as childhood obesity and diabetes.

As citizens, we too have overconsumed: gasoline, fast food, tobacco, television and health care. We spend nearly twice that of our international peers but rank a dismal 37th in overall health. We hold the innovative keys to the future of medicine but leave nearly 50 million Americans without access. Our health care costs are sapping our nation's economic vitality, making us less competitive in international markets.

 

 

 

 

And, to get a bit wonkier, a bipartisan group of policy experts (extra valuable precisely because bipartisanship is not exactly overflowing in Washington right now) working with the Brookings Institution and the Robert Wood Johnson Foundation outlined how to tackle that curve.

• Invest in better information and tools, such as health information technology, as a foundation to guide and support a reformed system. Health IT won't fix health care on its own, but we can't fix health care without it.
• Transition to accountable payment systems that reward providers for delivering lower-cost, high-quality care.  This goes beyond fiddling with fee scales in Medicare and Medicaid, this is a new way of demanding accountability, encouraging innovation, and rewarding quality.
• Restructure non-group and small-group health insurance markets and coverage subsidies based on an exchange that pools risk outside of employment and promotes competition on cost and quality.
• Support and encourage better individual choices to enhance the patient role in improving health and lowering health care costs.  This means patients become partners in caring for their own health. It also means investing in new prevention strategies to test how to reverse the obesity trend. (Think of it as bending a lot of other curves).

(Jane Sarasohn-Kahn also has her own take on the Brookings work at her Health Populi blog  and the RWJF Users Guide to the Health Reform Galaxy blog also addresses it.  And hat tip to Joe Paduda at Managed Care Matters for spotting the reports on premium trends).