Managed Care

 

Getting More for Our Health Care Dollar

Getting More for Our Health Care Dollar

Edie Castello

The United States spends considerable money on health care. Unfortunately, the clinical return on investment has been coming up short for years, according to Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally, an oft-cited Commonwealth Fund study.

Among the 11 nations studied in this report — Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States — the U.S. doles out the most dollars yet ranks last in overall quality. Perhaps most troubling is the fact that the findings are nothing new, as the United States has been in this trailing position for the past decade.

Even though the report has been reaching the same conclusion for a number of years, it is still met with disbelief. Health care professionals and the general population alike wonder how the country can spend so much money and still struggle to stay on par in terms of outcomes.

One of the problems causing the disconnect: The United States has all of the sophisticated facilities, advanced technology, and highly trained professionals required to produce great clinical outcomes. Often, however, no one is running the proverbial show. And as a result, the country’s health care organizations deliver care in a fragmented, disparate fashion, making it difficult to turn potential into reality.

A more deliberate focus on care management and coordination is one of the ways that the United States could close the spending to quality gap. The National Quality Forum asserts that care coordination “helps ensure a patient’s needs and preferences for care are understood, and that those needs and preferences are shared between providers, patients, and families as a patient moves from one health care setting to another.” Care coordination is especially important for people with chronic or complex conditions who receive care in multiple settings from numerous providers. The National Quality Forum also has stated that care coordination “maximizes the value of services delivered by facilitating beneficial, efficient, safe, and high- quality patient experiences and improved health care outcomes.”

The key to achieving the care coordination that will result in optimal clinical and financial outcomes rests in fully leveraging information technology while also providing highly personal service to plan members. Knowledge sharing between providers, members and family caregivers across the health care continuum will lead to reduced redundancies and the ability to make informed value-based choices. Maximizing the predictive power of analytics on a health care dataset to select members most needful of high-touch interactions moves care coordination from an expensive “nice to have” to an affordable “must have.”

Consider the following: Information technology is empowering. It can help organizations identify best practices and construct the roadmaps that can best direct clinical care. But you have to remember that health care is still highly personal. To succeed, health care organizations need to enable caregivers to work one to one with patients, providing the highly individualized guidance that comes only through personal interaction. In essence, high-tech only succeeds when it is used in tandem with high-touch interactions with the members whose health quality will benefit the most.

So, if we want to change the game in the United States, the two need to come together. The country’s health care organizations will finally start to see the improved outcomes that can truly justify the amount of dollars spent on health care in the United States.

 

Edie Castello is president and CEO of eQHealth Solutions, a not-for-profit healthcare IT and medical management services company (www.eqhs.org).

Meetings

Pharmaceutical Pricing and Contracting Conference Philadelphia, PA September 22–23, 2014
Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014