One point of consistency in the healthcare reform debate has been the level of partisanship: When it comes to discussing or voting on issues, Democrats are siding with Democrats and Republicans are siding with Republicans. This has been underscored in Washington this week as hearings began on the Senate Finance Committee's healthcare reform bill—America's Healthy Futures Act of 2009.
So, when a group of more than two dozen senators representing both sides of the aisle come together on a healthcare issue and send a letter to President Obama—inarguably that's news. Just a week ago, 28 senators (20 Democrats, seven Republicans, and one independent) sent a letter to the White House asking the president—as he works with Congress on the passage of healthcare reform legislation—to emphasize that there is a need to "realign spending in the Medicare program to focus on providing more value to beneficiaries."
"We support many of the Medicare payment reforms that are included in current versions of health care reform legislation, but believe additional effort must be made to get better care at a lower cost," they wrote. In addition, they said that a fundamental way to improve Medicare's efficiency is to "realign the Medicare payment system to reward health care providers for the quality of care they deliver [and] not simply the quantity of services they provide."
Many of these senators were from so-called "high efficiency" areas—including Minnesota, Wisconsin, Utah, Vermont, New Hampshire, South Dakota, and North Dakota—that are known for using integrated health delivery systems and innovative quality measures "to provide Medicare beneficiaries with better value." Research shows, they said, that their states’ healthcare organizations' efficient delivery practices could save Medicare upward of $100 billion a year—while also providing beneficiaries better access to the care they need.
But what is behind that high efficiency? Mayo Clinic's CEO and President Denis Cortese, MD—whose institution has been frequently cited by President Obama for its quality of care and service delivery—noted that many institutions nationwide provide high-value care: care that produces better outcomes, better safety, and better service in comparison to the amount spent for it.
"What we really mean by healthcare reform is the healthcare delivery we are getting . . . healthcare that helps keep us out of the hospital, keeps us healthy, keeps us working, keeps us in school, and maybe helps prevent people with chronic illnesses or chronic conditions from long suffering," he told a Washington audience last week.
Among those institutions, regions, and those states that have high-value organizations, Cortese said they have a few common characteristics:
- A higher level of a cultural focus is aimed at the needs of the patient. "There's more patient-centeredness thinking going on in those organizations or by those groups of providers that band together in communities or in states that have created better environments for caring for people," he said. "They are focused more on the patient."
- A higher level of physician or provider engagement, leadership, and change is found among those taking care of patients. Specifically, a higher level of teamwork and collaboration is implemented when making medical decisions for patients.
- A higher level of coordinated care is found where the teams use integration and coordination in managing the patients themselves. This can involve areas from how appointments are scheduled to are follow-ups.
- A higher rate of sharing of medical records and information is found from one place to another. "With these galaxies of good delivery of high-value care, there's a fair bit more of connectivity about information than there is elsewhere," Cortese said.
- Focus is placed on "the science of healthcare delivery." This means systemically looking at the ways patients flow through an organization—for instance, reviewing how certain processes can be done to reduce errors.
So, how does the country and all healthcare organizations get there? Cortese made a suggestion that it can start with Medicare as the country's largest payer—by paying for value. "The vision is to get there is a reasonable amount of time," he said.
And the country may be starting to point in that direction. Earlier this week, Senate Finance Chairman Max Baucus (D-MT) included an amendment in a modified version of his healthcare reform bill in which Medicare would place value of services over volume of service when paying for physician services. As proposed, Medicare under this amendment would begin paying for value beginning in 2015.
Cortese agreed that making a change to considering value can't happen all at once. "You can't jump a 40-foot chasm in two 20-foot steps," he said. Instead, it will take small steps—one after another—to make the big jump to value.
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