Archive for the 'Affordable Care Act' Category

Many of us have heard the mantra our whole careers: To improve health—and the quality of American life—we must stem the rising cost of care. Health care’s percentage of the U.S. gross domestic product has doubled since 1980. At this rate, by 2040, health care will consume one of every three dollars.

With a U.S. debt crisis and a presidential election looming—and with Group Health paying continually rising prices for care purchased outside our own group practice—the cost-containment drumbeat can seem deafening. But here are 10 reasons why rising costs matter now more than ever:

1. Dollars spent on health care could go to education and other needs.
As former White House Advisor Ezekiel Emanuel, MD, PhD, recently wrote, “The more we spend on health care, the less we can spend on other things we value…middle-class salaries, public education, and other state-funded services.” Money spent on any of those things may promote health more than spending the same on medicine. Also, health care-related debts are weakening American businesses’ ability to compete globally.

2. Lower costs will let more Americans gain access to care.
When insurance premiums rise with the cost of care, fewer people can afford coverage. Emanuel predicted that even after the Affordable Care Act starts providing coverage for the uninsured through Medicaid and subsidies in 2014, some people will still find coverage unaffordable. But bending the curve of cost increases should allow more Americans into the system.

3. Lower costs can be compatible with better care.
Group Health proved this true in our patient-centered medical home evaluation. Results included lower costs, higher quality, fewer hospitalizations and emergency visits, and better patient and provider experiences. Ongoing research seeks to identify more innovations that cut costs while maintaining or improving quality.

4. We know where the money is.
Studies show that the greatest potential for health care savings comes from reducing avoidable hospitalization and improving care for chronic conditions. In the Journal of the American Medical Association, Emanuel recently outlined needed changes, including many under development and/or evaluation at Group Health:

• tracking patients’ health status and physician performance with electronic health records
• more intensive interactions between patients, caregivers, and clinic staff, including using care coordinators, 24/7 access, interventions to increase medication adherence, and specialized clinical services for patients with recurrent problems from chronic disease
• providing services not traditionally covered by fee-for-service reimbursement, such as e-mail, wireless monitoring to increase medication adherence, home evaluations to minimize falls, and lifestyle interventions to improve nutrition and exercise

5. We’re uniquely positioned to help solve the problem.
As a learning health care system conducting non-proprietary research within an integrated health plan, we can study the processes and costs of care and coverage for a large population getting care in real-world clinical settings. This lets us continually refine our ability to design, implement, evaluate, and disseminate innovations that may reduce care costs for Group Health members and others across the United States.

6. We’ve got the connections.
Through Group Health Research Institute’s links to other organizations in the HMO Research Network and other consortia—and our collaborations with universities and medical centers nationwide—we can extend the diversity, power, and reach of our research on costs.

7. It’s the future.
The new Center for Medicare and Medicaid Innovation shows increasing interest in funding research to make care more efficient. Also, the establishment of accountable care organizations (ACOs)—as outlined in the Affordable Care Act—provides new incentives for cost-conscious health care.

8. Improvements are possible.
Other developed nations prove it’s possible to provide higher-quality care at lower cost. Among further glimmers of hope: the Centers for Disease Control and Prevention published a study last month showing a dramatic decrease in amputations among people with diabetes over the past decade, presumably because of better disease control. Such improvements should result in lower costs too.

9. We’re poised to address the problem.
At the Group Health Research Advisory Board Annual Meeting on January 25, leaders from Group Health and our collaborating institutions affirmed GHRI’s recently completed strategic plan. They encouraged the Institute to be more ambitious about solving cost control challenges—for both Group Health and the nation. So a small working group of Group Health leaders will meet soon to plan how GHRI will intensify efforts in cost-related research.

10. It’s our job.
GHRI’s mission is “to improve health and health care for everyone through leading-edge research, innovation, and evaluation.” Reducing costs of care is a pillar of this effort.