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Can Employers, Payers and Providers Get on Same Page?

by John Moore | June 02, 2009

healthcare_costs2In Massachusetts, two groups have been meeting, separately for several years to address rising healthcare costs. The local NPR radio station, WBUR had an interesting story today profiling these two groups and the conclusions they reached for controlling rising costs.

The first is a coalition of academic medical centers, hospitals and payers who concluded that the focus needs to be on quality.  Better quality = Better outcomes -> Lower Total Costs.

The second group is a collection of major employers in the state.  There conclusion is that costs are tied to treatment options and that for some procedures, more expensive treatments do not generate statistically different outcomes.  This is a hot topic in DC and among researchers who will see some $1.1B in federal spending go to “comparative effectiveness” research. The employer group in Massachusetts is now looking at various options to encourage (provide incentives) employees to choose the lower cost, but just as effective procedure.  Equal, but lower cost procedure = Lower total healthcare costs.

What is interesting here is that in the first case, it is all about preserving the physician’s right to chose what is best for their patient, but just insure that whatever is chosen is done using best practices to insure quality.  The second case is more of a rationing model, not always a bad thing, but it sure will crimp the style of many a practicing physician with a particiular hankering for a procedure simply because it may be what they know best, or perversly, what they can get the highest reimbursement for.  It is unfortunate, however, that these two groups appear to have never met together to jointly address the issue as all are stakeholders would ultimately benefit from a meeting of the minds.

Then again, the healthcare sector is a political minefield and maybe it is best to strike-out separately in different directions moving quickly to reach consensus.  Now the question is: How to take that consensus to the next level and execute on it.

One response to “Can Employers, Payers and Providers Get on Same Page?”

  1. John,

    Here in the Puget Sound area a few years ago the health care costs for local employers (including government) were increasing so quickly that it became clear that everyone needed to come together.

    We (I was one of the original members of the consumer advisory board and serve on the Health IT committee) formed the Puget Sound Health Alliance “a regional partnership involving employers, physicians, hospitals, patients, health plans, and others working together to improve quality and efficiency while reducing the rate of health care cost increases across King, Kitsap, Pierce, Snohomish and Thurston counties: and it now covers over 2 million people (through their insurance carriers).

    Alliance participants agree to use evidence to identify and measure quality health care, then produce publicly-available reports designed to help improve health care decision-making. Reports measuring the quality of care provided in the Puget Sound region, along with useful information and tools, can be helpful in health care decisions, including identifying effective care, choosing or designing health benefit plans, deciding which doctor to see, knowing what questions to ask to get the best quality, and understanding what we each can do to improve our own health

    We use claims data (and we are very aware of its limitations) to produce qualty reports http://www.wacommunitycheckup.org/ for now but we will eventually be able to move to using claims data to identify those clinics and providers that deliver exceptional care to their customer / patients. The quality committees include all of the players and are open inclusive by design and reference the national quality standards.

    Take a look at our reports for some ideas of how we use this. I would love your feedback as always.

    Sherry Reynolds – aka @cascadia on twitter
    Executive Director – Alliance4Health

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