Can America afford a new health care system that provides more choices, lower costs, better care and more coverage? We believe we can.  To do so we must change the way we pay for health care from the current system that pays for procedures to one that pays for performance.  The key is value over volume.

Unfortunately, too many people believe that more tests, procedures, and technology mean better health care outcomes.  But studies show that close to 30 percent of all health care spending each year, approximately $680 billion, goes to treatment and procedures that do not improve patient care.  In many instances, the over-utilization of health care actually leads to worse results.

It is estimated that nearly 100,000 Americans die every year as a direct result of inefficient medical care.  Another 1.3 million people suffer injury due to medical errors.  One in every five people released from the hospital are readmitted within 30 days due to inadequate follow up care.  Despite these statistics, America spends nearly twice as much per patient on medical care than any other country but we consistently rank lower in health outcomes.  It’s a shame that within the same state, one hospital spends on average $57,000 per patient in the final two years of life while another spends on average $104,000, with lower satisfaction among patients and their families.  

This difference exists due to the focus on the volume of care provided.  We need a value-based reimbursement system that rewards quality and cost-effectiveness. This is not a region by region or state by state fight; it’s a unique American challenge in need of a unique American solution.

Fortunately, there are models of care in our country that focus on the value of care and provide high quality at lower costs.  They do so by adopting integrated and fully coordinated care systems that focus on the patient rather than on procedures.   They rely on primary care physicians and care coordinators with well trained nurses who spend more time with their patients and make shared decisions on care.  They emphasize preventative and wellness programs while listening to the expectation of their patients in a shared decision-making model.  For these providers, this approach - a greater emphasis on quality - leads to better health outcomes.  The results indicate that a similar payment mechanism nationwide would save billions of dollars and better the overall outcomes of health care provided across the country.  We must look to these models if we are to truly reform our system.

The challenge in changing our health care system is two-fold.  First, Congress as an institution typically moves slowly, with many checks and balances that make wide reform difficult.  Second, Teddy Roosevelt, the first American President to call for sweeping health care reform a century ago, probably said it best, “one person’s inefficiency is another person’s constituency.”  We must overcome these challenges to reform health care so that we do not continue to ignore the inefficiencies of an increasing costly system.

The good news is that significant steps have been taken just last week to incorporate value as a component of Medicare reimbursement in the House health care reform legislation.  Measures to reward the quality of care will transform our current health care system and incentivize our providers to offer high quality care.

We believe we can find increased savings in health care with a payment system that rewards the value of care given rather than the volume of care.  If we can do this, we can make health care affordable to those who have it as well as those who don’t.