Improving health care
Two trillion dollars is a lot of money.
That's how much The Commonwealth Fund says its proposals could save in national health care spending over 10 years if we started now. And that's in reductions in spending growth, not cuts.
Perhaps more importantly, Commonwealth says the changes could improve the quality of health care.
The proposals were the subject of not one but two sessions at the health care conference I attended a couple of weeks ago, which was sponsored by Commonwealth and the Society of American Business Editors and Writers. I'd like to share my takeaway from each.
The first was from Commonwealth's new president, Dr. David Blumenthal. He previously served as chief health information and innovation officer at Partners Health System in Boston and, from 2009 to 2011, national coordinator for health information technology.
Blumenthal told us about overseeing the implementation of a hospital-transforming health information technology system. He acknowledged that it wasn't easy, he went over the positive results — and he said that meeting meaningful use standards is not the same as achieving that transformation. He also opined that if a health system overhaul is really effective, "You do it (the new process) automatically, because it makes you work better."
Blumenthal's presentation came just a few days after RAND Corporation did a follow-up on its 2005 study that said widespread use of electronic records could save more than $81 billion a year nationally. The follow-up showed decidedly mixed results on that sunny promise — this is a good read on it.
I left wishing, as always, for more facts. It's pretty easy to get hospitals to tell you how they're progressing on electronic health records; some number-cruncher can spout the percentage of the process they've finished, and the execs are happy to provide a couple of examples of how it's supposed to help.
"Supposed to" is the operative phrase there — how much quantifiable good EHR has actually done in a given institution so far is something I haven't heard much about. I'd like to change that.
The second Commonwealth presentation was from Stuart Guterman, vice president and executive director of its Commission on a High Performance Health System. He dropped the number I'd been wondering about, which puts the $2 trillion in context: Over the decade, absent Commonwealth's proposals, health spending is projected to cost $42 trillion.
That works out to a net reduction in spending of roughly 5 percent over 10 years. A different, more impressive, perspective shows health care spending as a percentage of GDP. Currently it's about 18 percent; without the proposal it's expected to rise to 21 percent by 2023, but Commonwealth thinks the proposals could keep it at 19 percent.
Moral of the story: There's no quick fix.
I'm familiar, of course, with the perspective that the Patient Protection and Affordable Care Act doesn't do much to improve or cheapen health care, just expands access. I'm not endorsing that view, but I will say that all the buzz about EHR and patient-centered homes, etc., could definitely foster the impression that the madness is about to end.
Hearing how relatively small the financial effects of all of the changes Commonwealth proposes reminded me that we have the most expensive health care system in the world, and that's not going to change easily or fast. Settle in for the long haul, folks.