The New Health Dialogue

Yesterday we wrote about the fire-breathing dragon states vowing to kill health reform (but, we were happy to learn, starting to implement it nonetheless). Today, we've got zombies.

Admittedly, we're a bit backwards. We wrote yesterday about the second half of the New America Foundation Health Policy Program's panel on implementing health reform, focusing on states and providers. Today we'll give you the first panel, a national overview. (Webcast here, all presentations here under "Event Materials").

Our New America colleague Shannon Brownlee, author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer, started out with those health care zombies -- myths, misperceptions or bad ideas that just won’t die. While the high prices we pay for health care services in the United States help explain the high cost of care, they don’t explain the steep rate of growth of health spending -- that curve we need to bend before it drives a stake through our economic heart. (We know that's vampires, not zombies, but you get the point). The culprit: “our dysfunctional disorganized and wildly inflationary” system and the geographic variation that the Dartmouth Atlas has documented. More care isn’t always better care. Often the opposite is true. Quantity of care does not give us quality of life, nor does it even give a longer life. It just gives us a more expensive medical system.

She listed four major goals of delivery system reform:

1) Health care must be more organized;

2) Health care must be more patient-centered, which means giving patients the information they need to make truly informed choices; (note the difference between informed consent and informed choice)

3) We need a science of health care delivery. We know how to do a lot of stuff in U.S. medicine. We don’t know when, where, and how best to use what we know;

4) Rein in growth and capacity of health care hot spots (think McAllen).

Her second zombie (she has a whole graveyard full but time was limited): This Is Not About Rationing. It's about reducing care that is ineffective or unnecessary or wasteful. It isn't about saying “No” because it costs a lot. We have about $800 billion of waste in the system every year -- a good place to start.

Next up Dr. Kavita Patel, who worked on health reform in the Obama White House and before in the Senate, reminded us that a lot of the groundwork for an improved health care system was laid in last year’s stimulus bill, the American Recovery and Reinvestment Act (particularly Health IT money and billions in help for community health centers).  The new law will build on those achievements. We’ll see medical homes for Medicaid patients being tested within a year, a new HHS office focusing on dual eligibles (people old enough or disabled enough to get Medicare, and poor enough to also get Medicaid). The Center for Medicare and Medicaid Innovation will also serve the double role of testing new models -- and then getting those that work out into the real world in wide use quickly.

Dr. Patel said that doctors, generally speaking, are “supportive but nervous.” (She knows, she reminded us. She's a doctor. Some of her best friends are doctors.) Physicians need to be educated about health reform -- and how it gives them new supports and new tools and new models that will help them help their patients.

Sabrina Corlette, director of health policy programs for the National Partnership of Women and Families, spoke about the Campaign for Better Care, which is trying to bring attention (and solutions) to the needs of the frail chronically ill and their family caregivers. She too spoke about the need for patient-centered care. Care that isn’t siloed. Care that is available 24/7 not from nine to five. Health care providers “that know us as a person, not just a collection of body parts.” Support so that we can manage at home, and make informed decisions. Health care reform will promote a lot of these team-based approaches to care, that will try to eliminate the fragmentation and do a better job of coordinating complex needs. Implementation will be challenging, she agreed, and we need to watch out for perverse incentives that could make providers wary of taking on high-risk expensive complicated patients. But overall, numerous elements in the legislation bode well for taking better care of our most vulnerable. “We think they (innovations within health reform) show great promise,” she said. They emphasize paying for value, improving quality, measuring and being accountable for outcomes. But implementation is key.