WBB's Thought Leadership

America is Focusing on the Wrong Metrics for Decreasing Healthcare Costs

August 1

Decreasing access to healthcare by cutting coverage for the underprivileged appears to be a “Band-Aid” solution and will not decrease the overall cost of healthcare in the long run.

Shifting from a fee-for-service to a fee-for-value model has many change management problems. Patients lack the knowledge to shop around for their healthcare and often, require the expertise of a physician to determine what care they need. Without a clinician’s input, many would forgo needed treatment and have worse health outcomes.

Excerpt: “We spend too much on health care in this country—U.S. health care spending has spiked to more than 17 percent of our gross domestic product. Insurance has become outrageously expensive, which is one of the reasons we need health care reform.”

“But there is no easy way for a patient to become “smarter” at purchasing health care. Insurance companies can experiment with financial incentives¬—or disincentives¬—all they want, but those can be dangerous for patients’ health. People can’t compare and purchase health care the same way they do with apples or airline tickets. The cost of medical treatment is shrouded in mystery and runs tens of thousands of dollars. The choice of which service is right is dependent on expertise that the patients often don’t have. When deductibles are too high, evidence suggests patients may opt to forgo care entirely. That may lower costs in the moment, but it won’t make anyone healthier. And it won’t lower the financial burden in the long run.

“Insurance companies fundamentally don’t have the clinical or managerial expertise to create the changes that health systems need to improve quality and reduce costs. Insurers won’t improve coordination between hospitals, streamline clinician workflows, or increase surgical safety standards. They won’t get patients to take their medications more often, come in for preventive care, improve health IT infrastructure, or reduce hospital infection rates. Those changes, the ones that truly drive efficiency and reduce overall spending in health care, will have to come from concrete changes in policy and the operational efforts of clinicians. Current policy changes are moving our health care delivery system in the opposite direction. Tom Price, our health and human services secretary and a staunch critic of Medicare’s bundled payment program, delayed mandatory experiments that would have tested outcomes-based payments on a national scale, despite evidence demonstrating cost savings. Similarly, with all eyes focused on the Senate bill, the Centers for Medicare and Medicaid Services released a proposed rule to exempt more than 100,000 physicians from a bipartisan program that would have shifted their services to a value-based care model.”

Sources: Slate

WNN Take: Although the rate of healthcare cost increases has somewhat flattened since the introduction of the ACA, the upward trend in costs has continued. Increased costs have not resulted in improved health outcomes, and the U.S. lags other developed countries in population health. In order to reduce healthcare costs and improve health outcomes, systemic changes are needed that reduce waste and increase efficiency and effectiveness. A Value-based care model would focus on outcomes, but new metrics are needed to measure the downstream effect of healthcare services, and to tie interventions to outcomes in a way that makes overall cost effectiveness accounting possible. Leading indicators are needed that will enable healthcare professionals to choose interventions that have the best health outcomes for their patients, at the lowest long-term cost.

Cited by Shannen Irwin


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