IOM report outlines strategies to improve care, reduce costs
WASHINGTON - The U.S. healthcare system has long been laden with growing inefficiencies, heightened costs and increasing complexities, all of which have stymied industry progress, according to a new Institute of Medicine (IOM) report.
In a live webcast held on Sept. 6 to promote the report, Mark Smith, MD, president and CEO of California HealthCare Foundation and chair of the IOM's Committee on the Learning Healthcare System in America said two fundamental issues are currently facing the U.S. healthcare system: cost and complexity. Thus the mission of the report was "to find the foundational characteristics of a system that is efficient," said Smith.
According to the report, which was sponsored by the Blue Shield of California Foundation, Charina Endowment Fund and Robert Wood Johnson Foundation, the costs of the system's current inefficiencies underscore the urgent need for a system-wide transformation. The committee calculated that approximately 30 percent of health spending in 2009 - roughly $750 billion - was wasted on unnecessary services, excessive administrative costs, fraud and other problems.
The U.S. pays some of the highest costs for healthcare, but "at the same time, we do not attain the results in health outcomes and performances that others are able to achieve," said IOM President Harvey Feinburg, MD, during the webcast. "How do we face up to that reality?"
Smith noted that a "30 percent increase in income has been effectively eliminated by a 76 percent increase in healthcare costs," leaving the U.S. healthcare system full of "wasted opportunity."
"We have the highest healthcare cost in the Western world and we don't have the kind of results we should have to show for it," added committee member Rita Redberg, professor of medicine, School of Medicine, University of California, San Francisco. "Healthcare is a huge part of our national debt. It is clearly unsustainable on its current trajectory."
Achieving higher-quality care at lower cost will require an across-the-board commitment to transform the U.S. health system into a "learning" system that continuously improves by systematically capturing and broadly disseminating lessons from every care experience and new research discovery, the committee said.
Smith outlined four tools that he said are "... at our disposal that were not at our disposal even 12 years ago" for reigning in costs and improving care quality: computing power, connectivity, improvements in organizational capabilities and teamwork and collaboration between clinicians and patients.
IOM's strategy calls on health economists, researchers, professional societies and insurance providers to work together on ways to measure quality performance and design new payment models and incentives that reward high-value care.
"Modern medicine is a team sport," said Smith.
Committee member T. Bruce Ferguson Jr., chair, department of cardiovascular sciences, East Carolina Heart Institute, Greenville, N.C., echoed the called for increased teamwork.
"It took everyone involved in healthcare to get us where we are and it's going to take everyone involved in healthcare to get us where we need to be," he said. "We all have to assume individual and collective responsibility for turning this ship around."
Report officials point to the necessity of embracing new technologies to collect and tap clinical data at the point of care, engaging patients and their families as partners and establishing greater teamwork and transparency within healthcare organizations. Additionally, incentives and payment systems should emphasize the value and outcomes of care, not the number of services provided.
"The threats to Americans' health and economic security are clear and compelling, and it's time to get all hands on deck," said Smith. "Our healthcare system lags in its ability to adapt, affordably meet patients' needs and consistently achieve better outcomes. But we have the know-how and technology to make substantial improvement on costs and quality."