Efforts to Reduce Healthcare Costs in America Almost Universally Fail
Doing the Same Thing and Expecting a Different Result
This is a great article from the Harvard Business Review.
“When corporate executives, health care leaders, and policy makers discuss the challenge of curbing U.S. health care costs, the conversation invariably turns to the sickest 5% of the population, who consume 50% of health care spending. For a long time the hope has been that improving the efficiency and quality of their treatment would significantly reduce the $3.5 trillion that the United States lays out annually for health care. Over the past two decades this thinking has led employers, insurers, and health systems to embrace expensive disease-management programs that, operating in parallel with patients’ primary-care physicians, use registered nurses and social workers to monitor, coach, and provide services to many people in the top 5%. While these programs do increase the quality of their care, our health system, Kaiser Permanente (KP), and nearly all others have found that they do not reduce net costs.”
There is good evidence about every element leading to better health at lower cost. Most programs to address the 5% fail because they don’t take into account the complexity of this population. These patients fall into three categories.
“People with one or more chronic medical conditions that could be improved or kept under control”
“People who suffer a onetime catastrophic health problem”
“People with severe chronic conditions who can’t be returned to good health and require expensive treatment continually”.
Categories 1 and 2 change from year to year. This is why most programs fail. They are not built to deal with this complexity.
Here is the solution
.”In parallel, KP developed a new model for treating people with multiple but relatively manageable chronic diseases—focusing on both those who are currently in the top 5% and those who could end up there in the coming years if their medical problems worsen and their health deteriorates. We believe that addressing this entire group of patients presents the biggest opportunity for improving outcomes and increasing savings. Our approach uses technology and relatively inexpensive medical staff to provide expanded support to primary-care doctors so that they can oversee and address the chronic needs of patients directly instead of relying on largely independent disease-management programs.”
The benefits of this new approach are dramatic. Kaiser can offer premiums that are 10% to 15% lower than its competitors’. The increased revenue also allowed KP to fund $1 billion a year in capital investments, to fund care for the under- and uninsured, and to finance medical education.
This is an advanced primary care model involving teams, protocols, technology and systems. The article is correct in that the first category is the greatest opportunity. The third category involves patients with severe chronic conditions who cannot be returned to good health because their organ damage has passed the point of no return. They mention patients with advanced congestive heart failure and patients on dialysis. These patients once were in the first category and most move to the third because our system let them down. Optimal medical therapy can slow their progression to the third category by decades.
The advanced primary care team for cardiometabolic disease delivering optimal medical therapy is the perfect model to apply this evidence. This model can be systematized, replicated, and scaled.
Don’t forget the needs for the accurate early detection and monitoring to effect primary lifestyle optimization prevention measures, in combination of or even before the need for OMT, Bill.