Let’s look to in­no­va­tion, not slash­ing pro­grams, to make health­care more ef­fec­tive, af­ford­able

Modern Healthcare - - COMMENT - By Kate Walsh

As the na­tional health­care de­bate con­tin­ues, what if in­stead of cut­ting Med­i­caid el­i­gi­bil­ity and cap­ping spend­ing, as the leg­is­la­tion ap­proved by the House of Rep­re­sen­ta­tives would do, we were dis­cussing in­no­va­tions that would make the health­care sys­tem more ef­fec­tive and af­ford­able?

Ul­ti­mately, that’s what pol­i­cy­mak­ers in both par­ties should want and the Amer­i­can peo­ple need.

The op­por­tu­nity is sig­nif­i­cant. Cur­rently 74 mil­lion Amer­i­cans—nearly 1 in 5 peo­ple—in our coun­try re­ceive cov­er­age through Med­i­caid, ac­count­ing for $554 bil­lion in state and fed­eral fund­ing. This in­cludes 40% of our na­tion’s chil­dren and two-thirds of peo­ple in nurs­ing homes, re­flect­ing the in­ter­gen­er­a­tional im­pact of this crit­i­cally im­por­tant pro­gram. There are mean­ing­ful ways to re­duce costs or­gan­i­cally with­out dra­matic bud­get cuts and cov­er­age re­duc­tions. Many of these so­lu­tions are al­ready in prac­tice.

A holis­tic ap­proach to care and fo­cus­ing on the so­cial de­ter­mi­nants of health has been in­creas­ingly rec­og­nized as a crit­i­cal com­po­nent of health. So­cial, en­vi­ron­men­tal and be­hav­ioral fac­tors have been shown to con­trib­ute sig­nif­i­cantly more to a risk of early death than ge­net­ics or med­i­cal care. By un­der­stand­ing and ad­dress­ing the spe­cific chal­lenges pa­tients face we can help them achieve bet­ter health out­comes and, in turn, re­duce health­care costs.

For ex­am­ple, about 1 in ev­ery 8 U.S. house­holds is food in­se­cure, ac­count­ing for an es­ti­mated $160 bil­lion in health-re­lated costs rang­ing from anx­i­ety and de­pres­sion in chil­dren to di­a­betes and hy­per­ten­sion in adults. And yet, as a health­care sys­tem we are still far more apt to treat the con­se­quences of food in­se­cu­rity and poor nu­tri­tion on health out­comes than to ad­dress and treat food in­se­cu­rity in our pa­tients. By rais­ing aware­ness of hunger as a health is­sue, de­vel­op­ing stan­dards for screen­ing and build­ing strong so­cial ser­vice part­ner­ships, we can have an im­pact not only on health but also on health­care costs.

Bos­ton Med­i­cal Cen­ter, the largest safety-net hos­pi­tal in New Eng­land, has been ad­dress­ing the so­cial de­ter­mi­nants of health to pro­vide bet­ter out­comes for decades. For ex­am­ple, we launched the first in-hos­pi­tal pre­scrip­tion food pantry back in 2001, which al­lows our doc­tors to ad­dress food in­se­cu­rity by pre­scrib­ing a three-day emer­gency sup­ply of food for the pa­tient’s house­hold. The ther­a­peu­tic food pantry, a part­ner­ship with the Greater Bos­ton Food Bank, has since ex­panded to in­clude a demon­stra­tion kitchen where we teach pa­tients how to make healthy meals tai­lored to their med­i­cal needs. We’ve seen a grow­ing num­ber of hos­pi­tals adopt and cus­tom­ize this model.

A sig­nif­i­cant cost driver for the health­care sys­tem is hos­pi­tal read­mis­sions. More than a decade ago care­givers at Bos­ton Med­i­cal Cen­ter cre­ated Project RED, a model for dis­charg­ing pa­tients in a way that pro­motes pa­tient safety and re­duces read­mis­sions. The sim­ple so­lu­tion was pro­vid­ing each pa­tient with an in­di­vid­u­al­ized, easy-to-un­der­stand color-coded book­let on how to take care of them­selves at home. The book­let in­cludes in­for­ma­tion on med­i­ca­tions and up­com­ing ap­point­ments; an il­lus­trated de­scrip­tion of the dis­charge di­ag­no­sis; and in­for­ma­tion on what to do if prob­lems arise be­tween hos­pi­tal dis­charge and the first out­pa­tient visit. A nurse or a phar­ma­cist fol­low up with a phone call a few days af­ter dis­charge to make sure the pa­tient un­der­stands the plan.

The Project RED model has since been adopted through­out the coun­try, with par­tic­i­pat­ing hos­pi­tals see­ing an aver­age 20% to 25% re­duc­tion in read­mis­sions. It’s an in­ex­pen­sive so­lu­tion that keeps costs down by keep­ing peo­ple healthy and out of the hos­pi­tal.

Pay­ment model in­no­va­tions have also demon­strated early suc­cess in rein­ing in health­care spend­ing. Mas­sachusetts saw dra­matic ben­e­fits in near-uni­ver­sal cov­er­age as part of Mas­sachusetts’ 2006 re­forms, and we are cur­rently im­ple­ment­ing an ac­count­able care sys­tem that will shift Med­i­caid pay­ment to shared sav­ings and risk while hold­ing providers re­spon­si­ble for qual­ity and out­comes.

I have seen first-hand the im­pact of in­no­va­tion and cre­ativ­ity in pro­vid­ing bet­ter health out­comes for pa­tients while re­duc­ing over­all costs. To­day, our coun­try—more specif­i­cally the U.S. Se­nate—has a his­toric op­por­tu­nity to trans­form Med­i­caid and the health­care sys­tem by ex­pand­ing that kind of think­ing. To miss that op­por­tu­nity would be penny-wise and pound-fool­ish, likely driv­ing costs higher and un­der­cut­ting the health of the mil­lions of Amer­i­cans the pro­gram serves.

Kate Walsh is pres­i­dent and CEO of Bos­ton Med­i­cal Cen­ter.

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