EVERY ONCE IN A WHILE, something makes a lot of sense with healthcare reform. One of those moments came last month in Marietta, Ga., at the Medical Banking Institute, during a presentation by Paul Grundy, MD.
Grundy’s presentation, on the Patient-Centered Primary Care Collaborative, was both depressing and exhilerating. In 45 minutes, he indicated both how poorly the American healthcare system is performing and the extent to which forces are lining up to change the system in order to boost performance.
Grundy is chairman of the collaborative and director of healthcare technology and strategic initiatives for IBM. He pulled no punches in describing the state of the nation’s healthcare system and the need for change.
“The fundamental foundational issue facing us as a buyer of healthcare is that we don’t buy comprehensive care; we only buy episodes of care,” he said. “Our primary care providers have been disintermediated from our patients because we don’t provide comprehensive primary care.”
Data from research doesn’t paint a pretty picture. It indicates the United States has the poorest performing healthcare system of 19 countries with developed economies, even though we spend heavily on healthcare.
One big sponge for absorbing resources is the administrative component of the American system. Grundy, who regularly works with the Denmark healthcare system, notes that it spends only 1.3 percent for administration, compared with estimates of 25 percent to 30 percent in this country.
While data lines up to support the need for strong primary care services in achieving an efficient healthcare system, the United States is bulking up on specialists. Meanwhile, data shows that quality goes down and costs go up in areas where there’s a higher ratio of specialists.
That conclusion makes sense to Grundy. In Denmark, physicians get incentives to stay on top of their patients’ care and be responsive to their needs, such as answering e-mails quickly or making appointments within two hours of a patient request. “Every single Dane knows exactly who their doctor is,” he said.
The Patient-Centered Primary Care Collaborative is organizing efforts to create the concept of a patient-centered medical home as a way to provide comprehensive coordinated care with the right systemic incentives to bring efficiency to the care system.
Of course, it has lined up support from four large professional organizations, which would appear to have vested interests in shifting to a system that gives more prominence to primary care providers.
However, support is deep and growing for the concept of a patient-centered medical home for providing comprehensive care. The collaborative’s Web site lists more than 100 members, including insurers, labor unions, employers and government groups.
Gathering that power and influence has caught the attention of lawmakers and policymakers. In a recent legislative committee call for the collaborative, participants indicated Congressional interest was growing and that the push should begin for a pilot project to test the concept, which facilitates partnerships between patient, physicians and the patient’s family, when appropriate.
As an observer at Grundy’s session at the Medical Banking Institute, I could see a discernable interest among attendees. Grundy was peppered with questions after his session, and it indicated to me that this audience “got it.” The problem is clear, and here at least is one possible approach for restructuring care delivery and financing that strikes a responsive chord.
“How was it?” Grundy asked me after the session when I approached for more information. “It can be pretty dry stuff.”
Is the collaborative and its approach the only answer needed for turning a dysfunctional healthcare system into an efficient dynamo? Sadly, the answer is no; there are multiple problems that touch every corner of the system and its financing.
But this gives me hope that some data-backed solutions that creatively merge care delivery, quality, healthcare improvement and financial savings could gain broad support among diverse stakeholders.
Perhaps one of Grundy’s first slides – showing the steep, upward, unsustainable growth in healthcare spending – will bring more groups to the table to figure out other ways to bring rational solutions to the current crisis. I hope to report that your organization is one of those with seats at the table.