A Sampler From Spending To System Transformation

Abstract

From the Editor-In-Chief Health AffairsVol. 31, No. 11: ACOs, Medical Homes, Nursing, Costs and Quality A Sampler From Spending To System TransformationSusan DentzerPUBLISHED:November 2012Free Accesshttps://doi.org/10.1377/hlthaff.2012.1198AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSAccountable care organizationsCosts and spendingQuality of carePaymentEconomic burdenOut-of-pocket expensesPharmaceuticalsPatient-centered medical homes This smorgasbord issue of Health Affairs contains entries in the health policy aficionado’s favorite food groups: costs, spending, quality, and outcomes. We also offer samplers on payment and delivery system reforms and the role of medical culture, and opportunities to reflect on cross-cultural comparisons, as between the United States and China. Accountable Care OrganizationsA group of articles on this topic leads off with Harris Meyer’s Entry Point, a posting from this early point in the ACO journey. Meyer cites data from the consulting group Leavitt Partners indicating that there are now 126 ACOs working with public payers such as Medicare and Medicaid, 161 working with private payers only, and 31 more working with both.Among these works-in-progress are four of the Brookings-Dartmouth ACO sites described by Bridget Larson and colleagues. There is also the academic medical center version now under way at the Robert Wood Johnson Medical School in New Jersey, featured by Alfred Tallia and Jenna Howard.This issue has healthy representation from ACO skeptics Lawton Burns and Mark Pauly. They agree that ACOs’ emphasis on superior care coordination and use of health information technology may improve the quality of care, but they are skeptical that such strategies will succeed in lowering costs.Underscoring the challenges, one of David Eddy’s two articles in this issue employs his Archimedes model to demonstrate that achieving a ten-percentage-point improvement on the performance benchmarks for diabetes control in the Medicare Shared Savings Program would produce no net savings for Medicare. These results suggest that ACOs will have to look beyond quality improvement to achieve cost savings.Elliott Fisher and coauthors weigh in sensibly in their discussion of a framework for evaluating ACOs. They suggest developing performance standards and a coordinated evaluation approach across all ACOs and payers, so that the nation will have a standardized set of metrics by which to judge this massive set of experiments as they unfold.Costs And SpendingArticles in this category this month contain important food for thought. Peter Cunningham employs data from the Medical Expenditure Panel Survey to explore what happened to high medical cost burdens on American households—that is, the effect of having health spending that exceeds 10 percent of family income. He finds that despite the recession of 2007–09, the percentage of people under age 65 with high health costs burden remained largely unchanged from 2006 to 2009.The surprising reason: Decreased family income was almost completely offset by decreased out-of-pocket spending on prescription drugs, almost all of which stemmed from the shift from brand-name medications to far less costly generics. This insight raises the question of whether there is anything else in health care’s future that could grant similar cost relief in the years ahead. Given what is now in the pipeline as far as costly specialty medications are concerned, there would seem to be plenty of cause to worry.The Medical CultureSeveral articles attack the issues of interprofessional relations, teamwork, medical culture, and the effect on quality of care and system transformation. As other articles have previously observed, these cultural matters can prove to be as important as any well-designed new payment system—if not more so.Paul Nutting and coauthors, who conducted the evaluation of the first national medical home pilot, observe that the biggest barrier for small physician practices attempting the transformation to medical home care teams was that they were “extremely physician-centric, lacked meaningful communication among physicians, [and] were dominated by authoritarian leadership behavior,” among other flaws. They suggest that many physicians will need a wholesale shift in their “mental models” to transition into “good citizens within the health care neighborhood.”Health Reform In ChinaTsung-Mei Cheng’s interview with China’s health minister, Chen Zhu, offers an update of that nation’s efforts to provide public health insurance for rural households and modernize much of China’s health system. The result: 95 percent of China’s population of 1.34 billion now has some form of health coverage, and there’s a community health services center for every street in China’s cities.And what a wonder: There’s no sign that the Chinese are dismissing all of this as some nefarious plot called “Chen-care,” either. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 November 2012 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF download