12 May Healthcare 2015: Without change, not a pretty picture
Madison, Wis. – Jim Adams, executive director of the IBM Center for Healthcare Management, posed a simple question to those attending WTN’s Digital Healthcare Conference: How many of you think the U.S. healthcare system is a well-oiled machine?
No hands went up, but there were a few snickers.
Their response to Adams’ tongue-in-cheek query illustrates that even healthcare professionals agree the current model is not sustainable, even with improvements to care and efficiency linked to the ongoing deployment of healthcare information technology.
Adams asserted that healthcare is in crisis as co-author of a 2007 IBM study titled “Healthcare 2015: Win-win or lose-lose? A Portrait and a Path to Successful Transformation.” The study is part wake-up call, part call to arms for healthcare stakeholders that will face a much different landscape in seven years due to factors like healthcare consumerism, diseases that are more expensive to treat, and new treatments and technology.
In Adams’ view, clinging to the status quo would simple perpetuate impacts that are already being felt, including the shift away from employer-base insurance and declining reimbursement levels for providers.
“We would continue to hear about reductions in benefits, and we would continue to hear about reductions in payments,” he said. “So if we continue along this path, it is very much unsustainable.”
The path to transformation
According to Adams, the United States now spends $2.1 trillion on healthcare and spends 2.3 times more per capita on healthcare than the average of the 30 nations that comprise the Organization for Economic Cooperation and Development. Yet for all this spending, the U.S. ranks only 22nd in life expectancy, 28th in infant mortality, and 30th in obesity among the 30 OECD countries.
Touting what he called value-based healthcare, Adams noted that 20 percent of the people generate 80 percent of the costs, and he said a value-based system would help move more people from active disease status to a healthy and low-risk status.
“The first thing we need to do is focus on chronic care and make sure we’re managing that well,” he said. “That’s where most of the costs come from.”
The next step, he said, would be to focus on prevention, prediction, early detection, and early treatment, all things that genetic testing eventually could drive. That’s not to say genetic predisposition to disease will be accomplished by 2015, however, because it’s very complex. As difficult as it was to sequence the human genome, Adams said it’s much easier to do that than to understand the interplay of genes.
“Most conditions are not mono-genaic – Huntington’s Disease is – but most of them involve the interplay of multiple genes, the environment, lifestyles, and a number of other factors,” he said. “But I think we can continue to move in that direction, not only to figure out what works for treatments, but some of these treatments are extremely expensive right now because they are focused on just a few patients.”
However long it takes to realize preventive care based on genetic tests, Adams said “we can’t just let diabetics progress to the point where they are severely ill, and then spring into action.”
Stakeholders roles in the transformation are identified in the IBM study. For example, it called on healthcare providers to expand their focus on episodic, acute care to include the enhanced management of chronic diseases. Similarly, health plans are called on to help consumers get more value from the healthcare system and assist caregivers, and consumers themselves are encouraged to assume more individual responsibility for their health.
Adams said stakeholder awareness of these roles is improving, but there still are some attitude adjustments to be made. “It’s growing, but there is still a lot of attitude of, `Pay me more money. Fix the other parts of the system,’” Adams said. “It’s very common when I start talking, for example, about an integrated delivery network for a group of doctors to have a very simple solution – fix those mean, old health plans.”
The stakeholder dynamic is important for very simple reason. “Either we fix this together, or it will get fixed in a way that nobody wants,” Adams said.
Universal coverage
Adams said part of the solution would be universal health coverage, which he expects to occur in earnest around the 2012 presidential election. “There are too many other issues that we’re dealing with right now, and healthcare is too difficult an issue for politicians,” said Adams, who expects universal coverage to evolve more on a state-by-state basis.
He also said universal coverage is important in healthcare’s transformation because the estimated 47 million uninsured Americans are part of the cost equation. “You can’t have 47 million people running around without coverage, and having to do the cost-shifting, and having them avoid medical care until it becomes incredibly expensive,” he explained. “We need everybody in the system. We need everybody playing, or close to everybody. We’ll never have complete universal coverage.”
Adams, who also advocated shared risk pools and changes in what is covered by insurance, does not believe the federal government will step up to solve the problem. Even though state governments “can’t print money like the feds can,” he believes the solution is coming from employers and the states.
John Wade, chairman of the Healthcare Information Management and Systems Society, agreed the federal government would have to change priorities, but he does not believe the job can get done without federal intervention. He said the federal government would be important in driving technology adoption, public education, and protecting privacy through legislation so there is public trust in consumer-driven tools like personal health records.
“The feds must play a larger role,” Wade stated. “I can’t argue with the statistics he [Adams] quotes, but there are alternatives. His way is not the only way to go about this.”
Bill Mortimore, managing director of Healthcare Growth Partners, said the U.S. has to make a fundamental decision about whether healthcare is a public good like education. Mortimore, who agrees with Adams’ assessment of the healthcare system, said an affirmative answer would move the nation away from its current, unsustainable model.
“So much is chewed up,” he said, “in confusion, chaos, and overhead that is not focused on better health outcomes.”
Other DHC coverage
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• DHC 2008: EMRs stimulate interest in personal health records
• DHC 2008: Electronic data management top concern for CIOs
• Sharing your health information: Is California RHIO defying the odds?
• Partners CIO touts integration of genetics and electronic health records