The Healthcare Imperative Lowering Costs and Improving Outcomes: Workshop Series Summary (2010) / Chapter Skim
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20 Consumers-Directed Policies
20 Consumers-Directed Policies
Pages 569-582
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From page 569... ...
Jennifer Sweeney of the National Partnership for Women & Families reviews research revealing that consumers are seeking partnerships with their healthcare providers; information and guidance about conditions and treatments; tools and support to care for themselves; and open communication that encourages questions, dialogue, and treatment preferences and respects cultural differences. She suggests that meeting consumers' needs and recognizing their place on the activation continuum must drive any engagement strategy.
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From page 570... ...
Enabling and rewarding individuals to choose the existing highest-value provider of care offers an immediate impact on the quality and affordability of health care for individuals today and would stimulate all healthcare providers to improve in the future. Because the stimulus for future improvement based on consumer choice is limited by access issues and provider loyalty, he asserts that payment reform remains essential.
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From page 571... ...
the information communicated to patients in these efforts is not necessarily accessible and understandable by consumers or amenable to decision making. Drawing on its work in approximately 20 communities around the country, the National Partnership has gathered significant anecdotal evidence of consumers' perspectives on value in a healthcare context.
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From page 572... ...
Separate payments for the services associated with care coordination and access and increasing payments to primary care physicians relative to specialists might diminish these financial barriers. Even if the financial costs are overcome, there will be considerable work left to communicate with consumers the importance of primary care and to encourage their use of primary care over specialty care.
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From page 573... ...
It is important to clearly define quality care; provide cost and quality information together; ensure true differentiation among providers so that they are not all grouped into a middle category; rank providers by performance; and avoid using medical jargon, statistics, and so forth. For examples of consumer-friendly public reporting, look to the Puget Sound Health Alliance Community Checkup (http://www.
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From page 574... ...
Conclusion The National Partnership's work with consumers and advocates across the country has shown that consumers cannot be expected to play a greater role in driving the healthcare system to deliver higher-quality care while lowering costs without being given the incentives, tools, and meaningful, comprehensible information necessary to understand health care from a value perspective. The strategies detailed above should be employed by consumer advocates and other stakeholders to help achieve this goal.
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From page 575... ...
Quality Laboratory x 0.75-1.25 Neutral Hi-tech imaging -- CT, MRI, x 0.5-1.5 Neutral PET Lowest-cost facility within miles Ambulatory surgery -- 16 x 0.5-1 Neutral procedures Lowest-cost facility within miles Pharmacy x 3.0-5 Neutral Optimal use of therapeutically equivalent generics >30% reduced Hospital -- 9 procedures x x 0.5-1 mortality and Top % of facilities complication rate Specialty physicians x x 8-12 5% improved EBM adherence; 2 specialties, top % >20% reduction in readmission rates NOTE: CT = computer-assisted tomography; EBM = evidence-based medicine; MRI = magnetic resonance imaging; PET = positron emission tomography; TMC = total medical cost.
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From page 576... ...
standards would improve quality by about 5 percent, and the readmission rate would be lowered by about 20 percent. Achieving these theoretical potentials requires giving patients credible information that is easy to obtain and integrate into the healthcare experience.
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From page 577... ...
Enabling and rewarding individuals to choose the existing highest-value providers of care offers an immediate impact on the quality and affordability of health care for individuals today and stimulates all healthcare providers to improve in the future. The stimulus for future improvement based on consumer choice is limited by access issues and physician or hospital loyalty; thus, payment reform remains essential -- paying for quality and efficiency (total cost)
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From page 578... ...
, and the GIC does not currently offer Blue Cross Blue Shield of Massachusetts or any major national plan. The GIC does not negotiate benefits with employee unions; premium contribution splits between employees and the state are determined by the annual appropriation act.
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From page 579... ...
In drafting its Request for Proposal for a new contracting cycle, the GIC required that health plans send their patient-anonymized book of business claims data to Mercer to enable comparisons of physicians on measures of quality and use of healthcare resources. Symmetry's widely used Episode of Treatment Grouping software was selected as the basic analytic tool to compare physician use of healthcare resources.
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From page 580... ...
The health plans, also unexpectedly, supported greater standardization of specialties to be tiered, quality measures to be used, and the elimination of supplementary plan-based measures. All plans now tier a core group of medical specialties, and only a few tier primary care physicians (PCPs)
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From page 581... ...
The CPI initiative addresses the roots of how physicians actually use healthcare resources: how they adopt -- or do not adopt -- nationally endorsed quality guidelines and their mind set about their responsibility for conservation of healthcare resources, not just in their own offices, but in all services they order for their patients. It is a much preferred alternative to asking state employees to forgo wage increases in order to pay for inefficiently delivered health care.
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