The Health Care Quality and Cost Council held its first day-long retreat at Worcester State College on Monday. The morning discussions focused on links between (and de-linking) quality and cost. The discussion included a reference to a fascinating NY Times article this past Sunday about the increasing use of CT scans to determine potential heart disease risk. This article gave a clear example of an expensive new technology being used with possibly little benefit to patients (and actually some degree of harm from the small increase in cancer risk as a result of the scan). The article touches on both consumer and provider demand for this technology.
This led to much discussion among Council members about the need to promote evidence-based medicine and about how the current system of financing health care encourages procedures that may not be in the best interest of the patient and may increase costs while decreasing quality. They also discussed the need to engage consumers (as well as providers and payers) in a way that encourages them to become more questioning about the care they receive.
In looking ahead to the coming year, the Council hopes to do some concrete work on cost containment. One of the Council’s goals established in the past year is to “Reduce the cost of health care. Reduce the annual rise in health care costs to no more than the unadjusted growth in gross domestic product (GDP) by 2012.” At the end of the retreat, the Council agreed to work on a 3-year plan in order to reach this goal. Council staff will present a framework for this plan at the next Council meeting. HCFA and our Consumer Council hope to see some concrete next steps on cost containment emerge from the Council and we also hope that quality is not pushed to the background.
As QCC member Jim Conway said during the retreat, the QCC and others in the health policy world need to do a better job of defining the cost savings that result from quality improvement (e.g., infections cost MA $200-$400 million and therefore reducing infections will save money), so that the links that we intuitively know often exist between the two are clear.
Deborah Wachenheim
I concur with Richard Parker above on the importance of focusing our lens on the overutilization of health care services. I just received a grant from the Medical Foundation to study this issue in-depth in the under-65 population in Massachusetts. I’m hoping to provide some useful evidence to stimulate conversation and action among insurers, providers, consumers, and policymakers on the issue of overutilization. Action in this area can not only save money but improve quality.
How wide is the gate, and broad the road, of this planned roadmap? Any exit ramps? Toll booths? Traffic jams? Speed bumps? Potholes?
I agree with Paul on the primary care payment but I think we need to understand how the plans price their products. It seems to me they price annually based on population, rating factors, etc. and ultimately gamble on the numbers of members that need care or worse, very intensive care. That pricing structure leaves no room for a long term view without any short term gains and it certainly doesn’t bode well for a significant cash outlay to boost primary care payments in the short term (1 year) while not making the needed gains in that same year. But can they build it in? and would they all do it? One plan is unlikely to do it in the absence of all plans doing the same thing because it would throw off their pricing structure as compared to their competitors (or cut into their margins). But we need some courage, creativity and leadership from the non-profit health insurers in Massachusetts. Perhaps a plan willing to outlay the cost of boosting primary care would win over members in the market place and make up for the initial expense. OR, would employers themselves actually pay an extra lump sum for primary care in exchange for improved health insurance pricing over the long term for their healthier employees?? And would government reinsurance of catastrophic cases help the health plans to achieve this goal?
Costs will continue to rise as long as there is patient demand for services that they think they need whether they do or not, and as long as doctors and hospitals are paid for doing more, whether it is needed or not. In the spirit of full disclosure, as an internist myself, I fully concur with Paul’s comment above that we could hold costs down if we were given the tools to do it. I highly commend you all to read Shannon Brownlee’s book, “Overtreated” for a quick overview of why we are where we are.
This is very aggressive given (1) demographic trends that are pushing more and more people into the ranks of needing hospital care; (2) salary trends in the health professions in MA that exceed inflation each year; and (3) new techologies and drugs that become the standard of care (either because there is evidence to support them or because the suppliers of them are really good at marketing both to MDs and consumers.) Given these factors, why do you think that you can slow down the growth rate to the overall rate of inflation? Please understand that, in saying that, I am totally in accord with Jim Conway’s view that quality and safety improvements can result in real savings. That is one reason our hospitals (BIDMC and BID~Needham) have set a target of eliminating preventable harm in our settings.
But you are seeking an overall reduction in the rate of health care spending within four years and seeking to rely on three items that — to date — have not had traction: payment reform, administrative simplicity, and chronic care management and prevention. We all look forward to the roadmap to see what new approaches you envision that might offer different results from the past.
I believe the only way to get control of individuals’ health care costs is, ironically, to increase funding to support primary care — thereby allowing primary care doctors to spend the time they need to do proper counseling, preventative care, weight control advice and supervision, exercise encouragement, and disease management (including assuring patient compliance with drug regimes for chronic illness). Why don’t the payers on your Council make a long-term commitment to that? They haven’t in the past because they say that consumers churn from one insurance company to another so often that they cannot reap the long-term benefits. But if they all did it, they would all share in both the short-term costs and the long-term benefits, and the churn would not be that relevant.
At its retreat, the Council agreed that during state fiscal year 2009 the Council would:
1) Build a roadmap for cost containment for the Commonwealth. This roadmap will provide specific direction for the Commonwealth on how to meet the Council’s goal to reduce the annual rise in health care costs to no more than the unadjusted growth in Gross Domestic Product (GDP) by 2012. The Council anticipates that the roadmap will address a number of far-reaching issues including, but not limited to: payment reform, administrative simplicity, and chronic care management and prevention.
2) Launch its consumer friendly health care quality and cost information website, and develop a plan for expanding the information displayed on the website.
Katharine London
Executive Director
Health Care Quality and Cost Council