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We're always looking for real-life examples of low-cost, high-quality care. Minnesota is a good place to look, and the state's largest health plan is a good place to start. Patrick Geraghty, CEO of Blue Cross Blue Shield of Minnesota, took part in a NIHCM health policy forum in Washington this summer and presented the "Minnesota Experience." He suggested that the nation's leaders embrace the Minnesota model -- because it works.
"The discussion we are having as a nation is really not just about health care but it's about health. Wellness, prevention, and quality outcomes is really what we are collectively thinking about," Geraghty said. Positioning itself as a "health" -- as opposed to a "health care" -- company, Geraghty described BCBS's effective, "disruptive innovation" model for delivering care. Steps he called for include:
Nearly a third of health spending provides no added clinical value to patients. Half or less of what physicians do is backed up with valid scientific evidence. On average, patients get the recommended care just over half the time.
For health policy wonks, these facts are well accepted and treated as crucial components to the case for health reform. But for average Americans, many of these figures would come as a surprise according to recent polling done by the Campaign for Effective Patient Care, in conjunction with Lake Research Partners.
The poll surveyed 800 Californians who voted in the last year's election. A brief summary of the findings is available here and toplines are available here. Below are some of the highlights that caught our attention:
I've met Dr. Doug Eby twice, exchanged emails, spoken on the phone, read articles by and about him, and I'm still not quite sure how he ended up practicing medicine in Anchorage, Alaska. But I do know that the innovations and quality he and his colleagues have achieved in a challenging setting is attracting notice in the lower 48.
Eby is a family physician and the medical director of a nonprofit health care system that serves Alaska Native people in Anchorage and far flung remote communities, some accessible only by air.
He has learned that a diagnosis and a pill don't necessarily make a patient well. And he has helped organize Southcentral Foundation (SCF), the tribal-owned system that has attracted notice nationally for its innovation and ability to find a better way to deliver quality health care
Before the makeover, he wrote:
We weren't surprised to hear President Obama back some kind of malpractice reform. As we wrote in back in July 2008, in March of this year, and in more detail this past July, Obama and key Democrats were sending just that signal to physicians' groups. Exactly what shape (or shapes) malpractice reform will take is not yet clear. But Obama emphasized on "60 Minutes" this Sunday that he is no fan of the strict limits on damages that Republicans have proposed repeatedly for many years -- and which have always been shot down in Congress even when Republicans had the majority.
Tort reform. That's not something that historically has been popular in -- in my party. But on Wednesday I specifically said that I think we can work together on a bipartisan basis to do something to reduce defensive medicine. Where doctors are worrying about lawsuits instead of worrying about patient care.
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.
After The Speech -- and the Outburst -- and some of the usual political chatter, ABC‘s Nightline went inside the Mayo Clinic to show Americans what President Obama is talking about when he says we'll have "delivery system reform" and integrated care. It's one of at least three in-depth television pieces we've seen recently (more below on PBS and CBS) that illustrate how we can get high quality, patient-centered care at a lower cost.
Mayo is a household word. People know it's world-class care. What they may not know, and what Nightline showed, is that Mayo isn't excessively expensive. It isn't inaccessible to ordinary Americans. And it isn't built around the most esoteric and exotic and high tech specialist solutions. Yes they have them there, state of the art, best in class, and all that. But Mayo is built on primary care. On teamwork. On care coordination. On health information technology. On putting patients first.
For me and millions of Americans, "if it's Sunday, it's Meet the Press." This Sunday I was cozied up with egg whites, everything bagels, and my morning caffeine when none other than Tom Brokaw conflated (incorrectly) the cost of health reform with the cost of a possible public health insurance option. This was disconcerting, both as a health policy analyst and a loyal fan of Tom Brokaw. I put down the veggie cream cheese and pondered: if Tom Brokaw -- one of the smartest and most trusted faces on TV -- has his wires crossed about the facts of reform, how far has the misinformation penetrated?
As we prepare for the President's Wednesday night prime-time address, it is worth reminding ourselves of a few things about the reforms being discussed in Congress.
A day in a real hospital ER has as much drama, triumph, and heartbreak as any TV show. USA Today chronicled 24 hours at the University of Virginia Medical Center in Charlottesville, VA. They asked everyone -- patients, doctors and nurses, concerned family members, housekeeping staff -- to share their experiences with the health care system, and what they think about changing it. USA Today writes,
Their experiences and observations underscore why changing the health care system has proved so hard for presidents and policymakers: the complexity of the system, the pressure from chronic diseases, the shortfall in preventive care, the high costs, the competing demands -- and the life-or-death stakes.
Everyone agrees they want to preserve the quality and technological advances of American medicine...Beyond that, though, the consensus frays.
And the interviews the reporters conducted suggested that a lot of the misinformation spread about health reform this summer had gotten through.
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?' "