We need to make some changes to change health care

Charlie Baker is the president and CEO of Harvard Pilgrim Health Care, Inc., a nonprofit health plan that covers more than 1 million New Englanders. Baker blogs regularly at Let’s Talk Health Care.

One of the reasons the operating model in health care doesn’t change much over time is pretty simple: most of the people who think about it, write about it, work in it and study it have trouble seeing the model any differently than they see it today. I was struck, therefore, by Hebrew Senior Life’s Len Fishman the other day when he and I served on a panel at the 30th annual meeting of the Massachusetts Health Data Consortium. We were told to discuss health care 30 years from now — me from the plan perspective, and Len from the long term care perspective. I went pretty far out there in my remarks, imagining, among other things, a world in which there were no health plans at all(!). Len did too. His presentation on the future of long term care could not have looked more different than what we have today. He literally re-imagined the whole thing. It was startling — and refreshing.

This question — is the future just like the past, or something different — was raised again for me earlier this week when Brian Rosman — a good guy with whom I almost never agree — posted a blog on the Health Care for All Web site that basically said that more publicly available information on health care cost and quality could/might/will lead to higher costs and higher prices, because no one really cares about costs, and if they do, they’ll flock to higher cost options, because they’ll think they’re better than lower cost ones.

It might be, in the short term, that more publicly available data on cost and quality will lead to higher costs. Hard to imagine, given how high costs are now, but certainly possible. Also hard to imagine, given the amount of chatter, mythology, rumor and competitive intelligence about who gets paid what by whom that already existing among people “in the biz.” For the most part — and I’m being overly simplistic here to make a point — the group who will learn something new when the MA Health Care Quality and Cost Council data becomes public is, well, THE PUBLIC. And I simply cannot see how a state policy maker — or a practicing doc — or an advocate like Brian — or an employer — or a health plan — or even a provider organization — won’t be better off over time knowing what’s really going on under the covers.

I was re-reading, for about the fourth time, Atul Gawande’s first book, Complications, the other day, and I came across his discussion about the rise of the patient in making difficult decisions about his or her own health care. Gawande points out that before the mid-1980s, the idea that a patient would have anything to say about his or her treatment or care was preposterous. Patients didn’t make health care decisions, doctors did. Period. And yet, here we are, twenty years later — in a far more powerful and complex system than the one we had in 1985 — and patients do have a much bigger say in what they get and what they don’t than they did twenty years ago. Today, clinical decision-making is more transparent — and shared — between patient and caregiver than it was 20 years ago. And I would argue we are better off as a result.

This whole cost/quality thing in health care needs to change. We need to take some chances. We need to presume that smart people — and I don’t mean just consumers, I mean everybody — will make better decisions about value, about cost and about quality — than they make today, if they have more and better data. It has always worked this way as far back as I can remember. There may be bumps and bruises in the short term. There always are. But I see no reason why it won’t work over time this time, too.

5 replies »

  1. The problem with health care is the government is too involved … get them out. They offer all these benefits to the major health insurance/care companies that make it virtually impossible for 1-1 doctor/patient type treatments anymore. When the gov gets involved the cost goes up and quality goes down .. just look at education 🙂

  2. With the rise in health care, people are have a difficult time to fund any health service even with the help of medical, medicare etc… we try to assese every clients need, if they are not able to afford health services, we help them find a alternate solutions.

  3. ++ for Sherry’s comments.
    “We were told to discuss health care 30 years from now”
    If we don’t take some action on global warming coupled with an ever increasing world population, healthcare will be the least of our problems. Will your children thank you for the planet they inherit? And will you be able to leave them enough money to pay for the fix, which you don’t want to pay for now?

  4. One of the assumptions of the consumer movement is that we will shop based on price versus quality and that we will have enough information at the point of care to make an informed decision.
    Unlike purchasing a TV, a car or a home I doubt that very many people at the point of purchase would over-ride their providers recommendations. If you have an elective procedure and have accurate cost data between two hospitals would you change your provider in order to go to a different one? When your husband is laying in the ER with a possible heart attack will you log onto a web site and change where he is treated?
    Less then 10% or 20% of people account for 70% of all health care costs with four known conditions. (heart disease, diabetes, etc) and the solution is not to imagine that they will shop for care. As long as we use a model that pays providers for services versus outcomes we are destined to get more of the same.
    There are some known simple solutions like providing case management and nurse managers to coordinate care, paying providers to make phone calls, implementing EMR’s and letting providers keep the benefits of their behavior (now cost savings accrue to insurance companies).
    Finally there is an assumption that some providers who are higher quality will have open panels to take the people who are with lower quality providers but health care is not like buying a widget. There is not an unlimited amount of high quality providers so the goal is to identify practices that have better outcomes and provider all providers with the incentives to provide them. If you punish the low quality providers or those that treat high risk patients you will red line those clinics and doc’s that work in low income neighborhoods

  5. While I understand the argument, I don’t agree that “more publicly available information on health care cost and quality could/might/will lead to higher costs and higher prices, because no one really cares about costs, and if they do, they’ll flock to higher cost options, because they’ll think they’re better than lower cost ones.”
    Data should be presented in a clear format and balanced with understandable quality information. If a consumer sees that a higher quality provider happens to cost less on average, I doubt that consumer will choose another provider with higher cost and lower quality. In fact, I would argue cost is (or should be) irrelevant in the decision.

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