by Christopher Cornue

Continuing from my earlier posting, The Commonwealth Fund recently published Bending the Curve – Options for Achieving Savings and Improving Value in US Health Spending. In it, they identified four areas of focus that, if implemented collectively and appropriately, could result in reducing national expenditures over the next decade while improving access, quality and population health. The first of these areas is to produce and use better information for health care decision-making. I believe that all of us in healthcare would agree that data & information are key to our ability to be effective in our respective roles – whether diagnosing patients, or trending our contribution margin. Similarly, I believe we’d all agree that access to this information is not easy, nor is it always complete or well coordinated. Next, translate these beliefs to our patients and other decision-makers in healthcare – how are they supposed to navigate our system and make informed decisions specific to health?

The policies recommended to “address information barriers that contribute to the inefficiency of our health system and undermine are outcomes” are grounded in three fundamental tactics:
• Promoting Health Information Technology
• Creating a Center for Medical Effectiveness and Health Care Decision-Making
• Patient Shared Decision-Making

Promoting Health Information Technology – the study focuses on the importance of widespread usage of information technology. This foundation is essential to ensuring our industry and consumers have an effective mechanism to support systemic efforts of improving health, coordinating care, and ultimately controlling costs. Among the details of the policies, they propose using 1% of Medicare expenditures in conjunction with a 1% tax on private insurance premiums to support activities to create effective healthcare technology. Additionally, they recommend federal matching funding (3:1 to help with healthcare adoption technology; and 15:1 to promote the development of Health Information Exchange Networks) for the states, with a high priority for safety net hospitals, rural providers and small practices. Examples include electronic medical records, process redesign efforts and health information exchange networks. Although the recommendation is for voluntary adoption, they suggest an alternative could be to require these efforts through Medicare’s condition of participation.

Creating a Center for Medical Effectiveness and Health Care Decision-Making – recognizing that providers need data to lead their clinical decision-making efforts, the report suggested the development of a shared public & private sector “center” to coordinate this critical information and improve decision-making among various groups. Not only would this information support the provider, but it would also be used by payers (for coverage and payment decisions) and consumers (to provide further information as they make health care decisions). Based upon research that states education to patients and the usage of clinical pathways or protocols help to reduce costs, the development of streamlined information should prove valuable. According to the report, the center would “have a mandate to produce and publicize information that identifies and encourages the adoption of best practices and authority to establish certain incentives that are consistent with that objective.” I believe this effort is similar to the “Map of Medicine” concept in England and Wales that I wrote a posting about in Fall 2007 and the larger Healthcare Commission (a topic for a future posting) in England.

Patient Shared Decision-Making – allowing a well-informed patient to be key in their healthcare decisions in consultation with (not exclusive to) their physician is a primary driver for this strategy. The study suggests the creation of patient education aids (PtDAs) prior to having high-cost, sensitive procedures (i.e., coronary revascularization for angina, mastectomy for early breast cancer, prostatectomy for benign prostatic hypertrophy, medical stroke prevention therapy, etc.). These PtDAs would be required by the CMS for fee-for-service Medicare beneficiaries. The provider would be responsible for ensuring the patient receive these documents, as part of their decision-making process, prior to their procedure.

Next for our Bending the Curve report discussion is Promoting Health and Disease Prevention.