Arnie Milstein from Mercer is probably the smartest “purchaser” in health care on quality. He’s also the only person explicitly linking the inefficiency in health care to the plight of the middle class un- and under insured….as in this story.
What do we know? 1) The low cost regions are 30% cheaper at no worse quality. 2) Within the low spending communities the lowest spending docs with high quality are still 15% below the average cost for the region — Boeing looked into this in Seattle. And medical errors are still a massive problem (Minnesota health policy adviser was going to have the wrong side of her brain operated on)
But we have the shark (Arnies turn at explaining the increase in spending over incomes) caused by the biomedical miracles. Arnie says that we shouldn’t shut off the shark (i.e. cut off new biomedical miracles). Cutler estimates that every year the shark adds 5 weeks to life expectancy
Answer is to a) rapidly adopt best known delivery methods — b) rapidly incubate cost efficient care delivery innovations so that improvement happens more quickly
So how to do this? a) improve performance measurement, b) increase performance sensitive payments c) faster vetting of cost saving innovations (e.g. no plan had done on ROI on their DM initiatives)
Have to speed up the process knowledge discovery-cycle, by i) expanding role of para-professionals, ii) using engineers to redesign engineer IT-enabled work flows, and then iii) source high end elective care globally. (He’s finding unbelievably cheap prices from JACHO certified hospitals in China)
This has worked elsewhere…on average since mid-90s retail has been gaining efficiency at 2.5% a years, finance at closer to 8%—but they’ve adopted scientific measures. Where this has happened in health care is worked well. Virginia mason is using engineering to reduce unit costs and volume of services, and has just written a letter saying the 50% of dollars are wasted and told its clients that.
He also believes that while not perfect salient public transparency is powerful (Julie Hibbard, Health Aff July 2005), but apparently employers and enrollees support tiering and provider selection preferred 2 to 1 over P4P. He thinks that overall P4P is “medically necessary reset” — but the middle class is not likely to be shielded in time. But it’s not enough to save them unless we really move quickly. I think he’s an optimist.