Reducing medical costs first order of business

By Richard H. Cooper

Now that the Supreme Court has ruled on the Affordable Care Act, it is time to turn national attention to addressing one of the most vexing problems facing our country: how to reduce health-care costs.

The status quo is too expensive and is unsustainable. Our country can’t afford it — and neither can patients, employers or taxpayers. Health-care spending is growing faster than the economy. With an aging population, health-care costs are draining money away from other critical needs including education and transportation. Now, with even more people eligible for coverage, controlling costs is essential.

One important step is to change the way health care is financed. The current fee-for-service approach drives up costs by paying for the amount of treatment and number of procedures rather than the quality of care. Providers are rewarded for treating illnesses, not preventing them. High-tech intervention sare often covered, but not enough money is allocated to prevention or to ensure people receive basic primary care, which is more cost-effective.

The good news is that pockets of innovators across the country are working to transform healthcare from the bottom up. These efforts could be the most groundbreaking part of health-care reform and lead to the most far-reaching changes.

Spurred by employers and insurers, providers are developing new models of care that focus on keeping patients healthy, not just treating patients when they are sick. Helping patients to remain well through prevention and disease management is a proven way to improve quality and reduce costs.

Electronic medical records make it possible to coordinate care and ensure patients follow recommended treatments. For example, a nurse might have weekly phone conversations to help a diabetic patient monitor their blood sugar. The on-going interaction avoids the need for more intense — and costly — interventions, including unnecessary hospital and emergency room care.Patients are pleased because they stay healthier.

The Boeing Intensive Outpatient Care Program is an example of how care coordination works and saves money. The Everett Clinic, Virginia Mason and Valley Medical Center worked with Boeing to help coordinate the care of employees who are high users of health services. These complex patients were connected to a multi-disciplinary care team that included an RN care manager and a supervising physician. A care plan was developed and executed through intensive in-person, phone and email communications. By carefully coordinating care and working to help patients manage their diseases, the cost of care for these patients was reduced by 20 percent while improving quality.

Costs can also be lowered through the use of evidence-based medicine — using proven treatments that result in the best patient outcomes. Without sacrificing quality, The Everett Clinic saved more than $88 million per year for patients, payors and taxpayers by prescribing generic drugs. Our pharmacists independently examine evidence to ensure prescribing decisions are based on good science, not effective marketing. Evidence-based protocols for advanced imaging (such as MRIs) reduced use by 39 percent saving more than $32 million annually.

Providers throughout the country are demonstrating that it is possible to reinvent health care and control costs through increased prevention, care coordination and evidence-based care. Adopting these kinds of innovations nationally requires political will — to set aside entrenched views about how money should be spent and to support a restructuring of payment policies to eliminate fee-for-service and pay for value. It also requires accountability from providers to deliver better care, from payors to reward better care, and from patients to make informed choices about their care.

As a society we have a moral obligation to ensure everyone has access to affordable health care. That’s why reducing health-care costs must become a top priority. Given the nation’s finances and the need to provide care to more people, delay is no longer an option.

Richard H. Cooper is Chief Executive Officer of The Everett Clinic, a multi-specialty medical center serving 295,000 patients throughout the north Puget Sound region.