I wanted to weigh in a little more on President Obama's message about how health reform can benefit people with insurance, as well as those without. He explained how we could pay for expanded coverage, in part, with savings from within the health care system, ie. by doing a better job than we do now in delivering high quality affordable care. And to prove this isn't just a theory, he cited two successful systems leading the way,  Intermountain Healthcare in Utah and the Geisinger Health System in Pennsylvania. 

Dr. Guy Clifton, a brain surgeon who worked on the New America health policy team last year,  highlighted some of Intermountain's work in his recent book.  One example: prostate surgery.

Dr. Brent James, a leader at Intermountain, told Dr. Clifton how data analysis revealed massive variation in a certain prostate surgery. To put it bluntly, some doctors simply did a better job than others.  Dr. James shared the data with the physicians (who could identify themselves by name but not their colleagues) but he didn't tell them what to do about it. He was sure the poorest performer would never speak to him again.  But he got a surprise. The low-ranked doctor later called Dr. James and thanked him. He has been shaken by his low performance, so he sought out advice from colleagues and adopted their better technique.  A year later, the poorer performing physicians had improved, variation was down, patients had fewer complications, and costs were reduced. 

James didn't tell the physicians what to do, he simply gave them information.  On their own, the doctors improved quality and reduced cost. They didn't want to be bad doctors. They wanted to be good ones.

Intermountain used similar research and management techniques to reduce the cost of a hip replacement by a third, reduce the number of post-surgical infections, and improve safety of labor and delivery. The outcome -- fewer complications (meaning healthier patients), lower costs. You can see why President Obama made it a model.  

Meanwhile, back East, the Geisinger system in Pennsylvania has been quite innovative in their own right.  Many in the health policy sphere are familiar with their ProvenCare initiative, or in more informal terms, "heart surgery with a warranty."  In most hospitals, if a patient has elective heart bypass surgery, is discharged but must return to the hospital a few weeks later, the hospital will receive another payment; in other words, it will receive more money for doing a worse job than expected.  ProvenCare offers one price for a 90-day warranty, just as you would expect if you bought a new appliance. 

Obviously, Geisinger needed to think about making sure it was really doing a great job to make sure this initiative would work.  Its cardiac surgeons developed a list of 40 best practices, such as when to give what drugs to bypass patients.  Surgeons can skip steps if they wish, but as time has gone on this has become more rare as they have seen for themselves that the best practices are indeed the best. (Naturally physicians have the authority to skip a step in specific cases where it would be contraindicated for a specific patient) If Geisinger is successful, reducing readmissions will save Medicare (and the taxpayers) money and improve the health of its patients. 

Both the New York Times and the Washington Post have written about Geisinger, we've interviewed its leader Dr. Glenn Steele, and you can read studies in Health Affairs  at the Commonwealth Fund.

The president mentioned the cost of doing nothing, something we are well aware of on this blog: health care cost growth outstripping wages, coverage becoming more expensive, and a growing deficit.  As he said, too many Americans are counting on Members of Congress to succeed.  These problems don't just affect the uninsured, they affect all of us.