Choosing Wisely: Trimming Fat in the Health Care Industry

Monday, May 21, 2012 | Leave a Comment 

In corporations, it’s common to implement and continuously refresh best practices to eliminate inefficient, low-value activities. A similar principle is now being applied to the U.S. healthcare industry due to excessive medical spending in the United States. David Cutler, an expert in Economics at Harvard University, suggests that one third—up to $750 billion— of our country’s medical spending does not contribute to improved health.

Through a campaign called Choosing Wisely, nine specialty medical groups have identified tests or procedures “commonly used in their field, whose necessity should be questioned and discussed.” The end goal: Reduce costs and improve care. Launched last year by a foundation of the American Board of Internal Medicine, the campaign galvanized around a controversial opinion piece by Dr. Howard Brody, director of the Institute for the Medical Humanities.

Since then, nine medical specialty societies have committed to this campaign and eight more are expected to join this fall. While the Choosing Wisely campaign is not the panacea for spiraling healthcare costs, it is surely a positive step forward in raising awareness about excess spending. Ultimately, by reducing healthcare costs we can ensure that all patients have access to safer, higher-quality care.

The original medical specialty organizations of the campaign, who are leaders in cardiology, oncology, radiology and primary care, last month released their recommendations for areas where healthcare costs can be trimmed. Suggestions include skipping treatments such as cardiac stress tests for annual checkups in asymptomatic patients and brain imaging scans after fainting. Arguably the most controversial recommendation is that oncologists limit or decline chemotherapy treatments for late-stage cancer patients; most oncologists agree that these patients would be better off receiving hospice care.

With reducing health care costs as its core mission, Choosing Wisely has certainly sparked a healthy but contentious debate. One argument against their recommendations is that cutting “waste” could actually be healthcare rationing in disguise. The campaign’s architects make it clear, however, that their fundamental goal isn’t rationing care or denying services to those who need them. Instead, they emphasize that Choosing Wisely is about eliminating care that has no value.

Measures to contain and reduce healthcare costs in this country are vital—especially in this uncertain economy. I support this campaign, not only for its potential to trim costs but also for its ability to fill a gaping void in today’s healthcare system: The troublesome lack of communication between patients and physicians. In addition to making doctors more accountable in their practices, Choosing Wisely’s recommendations also place equal responsibility on patients to ask important questions that may ultimately lead to better care.

The campaign is working with Consumer Reports magazine to broadly disseminate the list of “unnecessary” treatments and procedures; however, for the time being, there is no regulation that forces patients and healthcare professionals to treat these recommendations as rules. I believe it’s up consumers to question procedures that may be unnecessary. It’s really about making well-informed decisions and thinking before we act. After all, every test, necessary or not, has a cost to the system.

I urge you to get involved. Read the lists from the nine partners and use these resources to learn how you can be a smarter patient. Then tell me if you agree or disagree.

Sarah Hurley is a consultant at Greenough. Follow her on Twitter at @Sarah_Hu

Accountable Care Organizations: Here to Stay?

Wednesday, April 11, 2012 | Leave a Comment 

It’s clear that no matter how the Supreme Court rules on healthcare reform, the way health care is delivered in the U.S. is changing dramatically. The consensus among healthcare experts is that a new delivery model called the Accountable Care Organization (ACO) is here to stay.

The ACO model brings healthcare providers together under one business umbrella to manage the needs of patients. Unlike the HMO model of the 80s, which was led by insurance companies, the ACO approach is driven more by physicians and hospital groups. The goal with this model is to increase the quality of care while keeping costs down. Providers share any cost savings associated with their services as long as they meet certain quality-of-care requirements. The move is a significant one; it’s taking the industry from what has traditionally been focused on fee-for-service with rewards for volume to more of a shared-risk strategy that relies on fee-for-performance. Unlike HMOs, this model is also patient-centric; the goal is to improve quality and lower costs – without limiting choice (which, as many will remember, was one of the leading consumer frustrations with HMO plans).

ACOs are still in their infancy, but many healthcare providers are pooling their resources.  Local companies, such as Waltham, Mass.-based Medventive, stand out by helping healthcare organizations use technology, including clinical-integration and risk-management tools, to successfully transform themselves into ACOs. Other key strategies of successful ACOs include integrated-care models that improve communication between primary care doctors, specialists, hospitals and other caregivers and allow providers to focus more on case management and preventative care.

In Massachusetts, Senate President Therese Murray is working on a major healthcare bill that would also move the industry away from a traditional fee-for-service approach and toward more of an ACO approach. The bill is another effort by the Commonwealth to address the soaring costs of healthcare.

In recent remarks to the Greater Boston Chamber of Commerce, Murray noted that “Hospital systems have stepped up their efforts to provide quality health care within set budgets.” Murray referenced five Massachusetts healthcare systems that were recognized this year by the U.S. Department of Health and Human Services as “Pioneer Accountable Care Organizations” for “providing better care at a lower cost by emphasizing primary, preventative care, improving integration between doctors and reducing unnecessary tests and hospitalizations.”

Thirty two Pioneer ACOs have been selected nationwide –including Partners HealthCare, Steward Health Care System, the Beth Israel Deaconess Physician Organization, Mount Auburn Cambridge Independent Practice Association and Atrius Health in Massachusetts.  The purpose is to test different payment arrangements for Medicare beneficiaries that support these organizations in providing better outcomes at a lower cost and, ultimately, to demonstrate the viability of the ACO model to all patients. As Dr. Gene Lindsey, president and CEO of Atrius Health, said in a recent article, Atrius “follows the ‘Triple Aim’ — high-quality care of the individual, improving the health of populations and doing it all at sustainable costs.”  That sums it up nicely.

What do you think? Will ACOs succeed? Why or why not?

Stacey Mann is EVP, Account Services for Greenough. Follow her on Twitter @sliedermanmann