Pa­tient-cen­tered care vi­tal to out­comes, cost

Modern Healthcare - - Front Page - Scott Arm­strong Scott Arm­strong is pres­i­dent and CEO of Group Health Co­op­er­a­tive, Seat­tle.

Pa­tient-cen­tered care is vi­tal to out­comes, cost con­trol

Heated dis­cus­sions rage over ris­ing costs and the lack of ac­cess to af­ford­able care. Med­i­cal pro­fes­sion­als ar­gue about whether we should pay for pre­ven­tion or just pro­ce­dures. Ac­cu­sa­tions fly about how changes to the way med­i­cal care is de­liv­ered could lead to so­cial­ism.

While it may sound a lot like the great Amer­i­can health­care de­bates of the past few years, what I’m ac­tu­ally re­fer­ring to is the tur­bu­lent time in 1946 when Group Health Co­op­er­a­tive, the Seat­tle-based health­care or­ga­ni­za­tion I lead, was cre­ated.

Back then, the nation was re­cov­er­ing from a long war, and hun­dreds of thou­sands of men and women were strug­gling to find af­ford­able med­i­cal care. In re­sponse, a small group of ide­al­is­tic men and women launched a noble ex­per­i­ment to cre­ate a health­care or­ga­ni­za­tion with a clear mis­sion—to serve the great­est num­ber of peo­ple with the best pos­si­ble care.

They be­lieved that by in­te­grat­ing pay­ment and care in a sin­gle group that paid doc­tors a salary to fo­cus on pre­ven­tion as well as treat­ment, they could of­fer med­i­cal care that cost less and de­liv­ered bet­ter out­comes.

This was a rad­i­cal ap­proach in 1946 that not ev­ery­one agreed with. The lo­cal med­i­cal so­ci­ety black­listed our doc­tors. And yes, the Amer­i­can Med­i­cal As­so­ci­a­tion de­nounced our sys­tem as the be­gin­nings of so­cial­ized medicine.

Now, 64 years later, there is a grow­ing recog­ni­tion that in­te­grated, pre­ven­tion-based care is the key to de­liv­er­ing the af­ford­able, high-qual­ity care that all Amer­i­cans are search­ing for.

In­creas­ingly, pol­i­cy­mak­ers and lead­ers from other health­care or­ga­ni­za­tions are ask­ing Group Health to share some of the lessons we have learned over the past 64 years So what have we learned? First and fore­most, we’ve learned that great care is pa­tient-cen­tered care. We know that the most im­por­tant de­ci­sions peo­ple make about their health hap­pen out­side the doc­tor’s of­fice. Pa­tient-cen­tered care pro­vides a way for physi­cians to en­gage pa­tients as ac­tive par­tic­i­pants in ev­ery as­pect of their health. Pa­tient-cen­tered care also pro­vides the frame- work for cre­at­ing in­te­grated group prac­tices where teams of peo­ple—doc­tors, nurses, spe­cial­ists and pa­tients—work to­gether to achieve the best pos­si­ble out­comes. And it en­sures doc­tors are ac­count­able to pa­tients for pos­i­tive re­sults rather than to in­surance com­pa­nies for billing codes.

This leads to a sec­ond crit­i­cal les­son: How you pay for health­care makes a huge dif­fer­ence. Chang­ing in­cen­tives so doc­tors are re­warded not for the num­ber of pro­ce­dures they per­form but in­stead for the health of their pa­tients is an es­sen­tial step to cre­at­ing a sys­tem where af­ford­able, qual­ity care is achiev­able.

We’ve also learned that ev­i­dence is es­sen­tial. We know if we don’t mea­sure our work care­fully and con­sis­tently, we can never know how ef­fec­tive we are. So we con­stantly ex­am­ine the care we pro­vide to un­der­stand where we are mak­ing progress and dis­cover where there is room for con­tin­ued im­prove­ment.

By con­stantly mea­sur­ing what we do, we also are be­gin­ning to col­lect a body of ev­i­dence that strongly in­di­cates we are on the right track in many im­por­tant ways. For ex­am­ple, hos­pi­tal read­mis­sion rates for Medi­care pa­tients across the coun­try hover around 20%. Group Health has low­ered that num­ber to 14% dur­ing the past year, and our rate con­tin­ues to fall. As a re­sult, we save about $50 mil­lion each year in un­nec­es­sary hos­pi­tal costs. And changes to our en­hanced pri­mary-care sys­tem are en­abling our pa­tients to avoid un­nec­es­sary emer­gency vis­its and hos­pi­tal ad­mis­sions. This is help­ing us save more than $40 mil­lion a year.

There’s one fi­nal les­son that is im­por­tant: We will never have all the an­swers. There is al­ways room for im­prove­ment and in­no­va­tion. Around the coun­try, there are ex­cit­ing ex­per­i­ments un­der­way to find new ways to or­ga­nize, de­liver and pay for health­care.

If we can keep an open mind, learn from the suc­cesses—and fail­ures—of our col­leagues in other or­ga­ni­za­tions, and con­tinue to fo­cus on what works best for pa­tients, I be­lieve we will find the an­swers we are look­ing for.

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