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The best health care at the best price
by Mary Brainerd, HealthPartners president and CEO
 What's the value of health care when you have a health crisis? You know one credit card's answer: priceless. But if you're one of the increasing numbers of Minnesotans who are paying more for health care, you're probably wondering: How much will my care cost? Why does care at one hospital cost more than another? Which hospital or clinic will give me better care?
Those questions are the reason several health plans are organizing hospitals and clinics by tiers based on cost and quality. For years, no one talked much about quality and cost of health care. That discussion has arrived and is here to stay. So the real question is not "Should we use tiers to identify the best and most cost-effective care?" The question we must address is "What's the best way to do it?"
Consumers who are making a major purchase can use tools like Consumer Reports to see which products are the best value. Tiering is one of the early efforts to create a "consumer reports" for health care. But do you measure quality in patient satisfaction, clinical results, staffing levels or something else? Some tiered plans might use a handful of quality measures while others, like HealthPartners, have more than 70 measures.
If your child needs surgery, you want the best care available and you'd probably be willing to pay more for it. Minnesota has some of the best health care in the nation, but not all care is equal in quality or cost effectiveness. Consider the case of two patients who have diabetes. Patient A, we'll call him Bob, is rushed to the hospital when his blood sugar drops and he blacks out. Doctors work with Bob to get his blood sugar under control and he is discharged feeling much better. He liked his doctor and hospital, and feels pretty satisfied.
Patient B, we'll call him Joe, is also rushed to the hospital when his blood sugar drops suddenly. Doctors get his blood sugar under control, but before he is discharged, they also check his cholesterol and his blood pressure -- both are too high. His physician writes a prescription for each and tells Joe he should take an aspirin every day. He also asks Joe if he smokes, congratulates him on quitting several years ago and he writes out a reminder for Joe to see his primary care physician in six weeks.
Fast forward three years. Joe hasn't been hospitalized again. His blood sugar, blood pressure and cholesterol are all under control. He's taken his doctor's advice to join a health club where he works out regularly. In contrast, Bob has been hospitalized several times. Medical complications result in his foot being amputated and he's having eye trouble that could lead to blindness.
These examples show that getting the right care the first time is more effective medicine and it's more cost-effective. About 10 years ago, HealthPartners created a program to deliver the best care for patients with diabetes. The improvement in quality of life is priceless. Every year, this disease-management program prevents 75 heart attacks, 125 amputations and 400 eye complications. Patients who receive the best care incur about $1,500 a year in medical expenses compared to $20,000 in medical expenses for patients with poorly managed diabetes.
We've reached some agreement about how to measure health care quality. Minnesota's Community Measurement Project is the first in the country to offer consumers a single source of information. But there's little agreement on what services should cost and how they should be reported.
Tiered health plans can give consumers information to buy smart. It's not smart to buy quality at any cost or to only consider cost at any quality. A smart buyer considers both. Most patients, doctors, hospitals and health plans share the same goal: the best care at the best price. "Tiering" is an important step toward reaching that goal.
Mary Brainerd is HealthPartners' president and CEO. She can be reached at mary.k.brainerd@healthpartners.com or (952) 883-6000.
© 2005 American City Business Journals Inc.
Editor's note: This article appeared June 24, 2005 in the Minneapolis St. Paul The Business Journal
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