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What we can do now to reform health care
by Mary Brainerd, HealthPartners president and CEO
The Minnesota Citizens Forum on Health Care Costs has outlined solutions to make health care affordable for all Minnesotans. Now we need to act on Forum recommendations and drive true reform of our health care system.
The Citizens Forum report calls for full disclosure of quality and costs and for dramatically improving quality. The report rightly states that most Minnesotans are in the dark about where our health care dollars go and about the wide variation that exists in quality of care and price.
Better care is a better value
Giving Minnesotans access to information about the quality of care is a critical step in correcting one of the biggest problems in American health care. Most Americans are not getting the best care available. A groundbreaking report from the RAND Corporation found that nearly 50 percent of the time, Americans who need treatment for more than 30 common chronic conditions like diabetes, asthma and arthritis are not receiving the care that would benefit them. Patients and their families pay for this lack of care in dramatically reduced quality of life or even needless death.
Lack of care also results in increased medical expenses. For example, a patient with diabetes who is not receiving the right care is likely to develop illnesses that lead to blindness, limb amputations and heart attacks. These tragic outcomes can be prevented by ensuring that patients get the right care at the right time to control blood sugar, blood pressure and cholesterol. The medical costs are three times greater for patients who do not receive the right care than for patients who do.
Report health care quality
Minnesota is a national leader in reporting health outcomes. The Institute for Clinical Systems Improvement is a Minnesota-based organization that provides health care guidelines developed by physicians and nurses based on the best available evidence and subject to an intensive review process. In addition, the Minnesota Council of Health Plans and seven Minnesota health plans are collaborating on the Minnesota Community Measurement Project to give citizens information that allows them to compare the performance of medical groups. Improving diabetes care is the groups initial measurement focus and the first public results are expected to be available in 2004.
HealthPartners has been measuring and reporting on the delivery of care for more than ten years and consumers can access this information on our
Web site
. The data shows, for example, that the number of HealthPartners patients who have had to undergo limb amputations due to complications of diabetes has decreased 45 percent. That translates to 100 HealthPartners patients each year spared the tragedy of a limb amputation.
Reward quality not volume
The Minnesota Citizens Forum also calls for a system that pays for value, rather than volume. The current system typically pays for procedures, tests and care regardless of whether it improves health or quality of life. Measuring and reporting health outcomes allows us to financially reward medical groups and hospitals that are providing the best care.
The private sector is taking important steps to do this. For example, HealthPartners pays clinics to deliver the best care based on certain measures such as assuring patients with diabetes or heart disease get all the care they need including preventive care. We measure outcomes and provide higher payments to clinics that do a better job of providing the best care. I believe the state and federal government should adopt this model.
I commend the Minnesota Citizens Forum for raising these important issues. Together, the government and private sector should establish performance measures and agree on a system that rewards the delivery of the best care. Expanding on initiatives already underway will give consumers information they need to choose the best care. It will allow health plans to reward care that delivers the best results. And it will help us provide affordable, quality health care for every Minnesotan.
Editor's note: This commentary was published March 14, 2004 in the St. Paul Pioneer Press
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