Cooperating for better care.

Robert Pearl

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Healthcare delivery, not just insurance, must be transformed

A rather simple delivery system.

— Photo by Rudiger Wolk

Beyond the sound and fury over Republican efforts to kill the Affordable Care Act, some providers are renewing calls for healthcare-delivery reform, says a piece in Health Affairs by Robert Pearl, M.D., and Norman Chenven, M.D.  They have led, respectively,  two of the nation’s highest-performing healthcare systems: Kaiser Permanente and the Austin Regional Clinic.  Dr. Pearl is chairman and Dr. Chenven vice chairman of the Council of Accountable Physician Practices.

Among their observations:

“Policymakers who are focused predominantly on how to improve the health care system by providing health insurance coverage will fail unless they simultaneously focus on transforming and modifying the delivery system; otherwise, the cost of providing that care will erode any program they create, whether coverage is provided through private insurance, Medicare, Medicaid, or another method. For this reason, we encourage the new Administration and members of Congress to consult and rely on the nation’s physician leaders, in addition to health insurance executives, to help chart the course for American health care in the future.

“While there are many different ‘levers’ to pull for delivery system improvement, three are absolutely fundamental to bringing about positive change and enhancing the doctor-patient relationship: As a nation we will need to move rapidly from fee-for-service to value-based reimbursement, and from paper and stand-alone computer systems to comprehensive, integrated, and mobile electronic health records. At the same time, we will need to track quality and patient satisfaction in ways that improve clinical outcomes without overly burdening physicians. We believe that all three of these objectives can be accomplished, and that they need to be central to the approaches and legislation currently being contemplated by policymakers.”

They conclude:

“The impending crisis in health care in this country will not be averted, regardless of what happens to the Affordable Care Act, unless as a nation we move from fragmentation to integration, from volume- to value-based payment, and from paper records and stand-alone computers to interoperable and comprehensive electronic ones. If these delivery system issues are ignored in the rancorous debate about health care coverage, then no matter the outcome, the system will fail.”

To read the piece, please hit this link.

Far to go on patient-physician digital dialogue




Now here’s an area that if  only modestly improved could probably save everyone a lot of time and money and improve medical outcomes.

A Nielsen survey says that most patients can’t use e-mail, texting and other electronic tools to share, back and forth, medical information with their physicians because many providers don’t offer such access.

The survey polled more than 5,000 Americans ages 18-65 on their technology attitudes and use to manage their medical care. Only 21 percent had  access to online physician-appointment-scheduling;  just 15 percent used email to communicate with their providers, and only 9 percent  got text reminders

“All the functionality that we live our lives on isn’t available in health care. You use your phone every day to send a text message or e-mail; you can’t do that to over 90 percent of physicians. You take a picture, and you want to send it someone; you can’t do that [with doctors’ offices] today,” Robert Pearl, chairman of the Council of Accountable Physician Practices, told The Washington Post.


4 steps to reduce unnecessary care


Robert Pearl, M.D., writes in Forbes on how to cut back on unneeded healthcare.

He offers four steps:

1. “Empower patient decision-making. New tools, including interactive videos, can help patients objectively evaluate the pros and cons of procedures and treatments. ”

2. “Shift to value-based pay practices. Paying for the value of care, rather than for the volume of services, would eliminate the perverse incentives in the current fee-for- service reimbursement system. A major step in that direction was the announcement from the U.S. Department of Health and Human Services to shift 50 percent of Medicare reimbursements to reward higher quality and pay based on clinical outcomes by 2018. ”

3. “Determine when new approaches are really better. To help accomplish this, every medical journal should require authors to compare new procedures, devices and drugs to current, often lower-cost alternatives. In a similar vein, the FDA should revise its charter to enable it to require that existing therapies be compared to new drugs and devices prior to approval.”

4. “Reform medical malpractice. Changes to litigation for medical malpractice would lessen the burden of unnecessary care associated with defensive medicine. What motivates many doctors to do too much for patients, including much they would never choose to do for themselves, is fear of missing an extremely unlikely problem and being sued.”


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