Sunday, March 23, 2008

New Beginnings in Healthcare

Its been a short while since I have posted. The main reason being the wealth of new knowledge and lessons learned at the American College of Healthcare Executives, 75th Annual Congress on Healthcare Leadership. The theme of this years Congress was Redefining Healthcare. Much to ponder from new insights and understandings.

An under-current of thought at the Congress was the sense that healthcare is undergoing some fundamental restructuring. No, not the kind that really addresses the underlying systemic process and care issues, not the "medicalized" social issues like the estimated 47 million men, women and children without health insurance, nor the crisis in Medicare solvency. The kind of change that over a generation will have a basic and fundamental shift based on the transparency of quality and data reporting.

Where we were

Healthcare in general for far too long, has been mired in secrecy and arrogance. No data releases, no voluntary reporting of adverse events, little effort to report how well a hospital does what it does. It is what is is, but that is really beginning to change. And I call the change the Age of Quality Transparency. An evolution of sorts.

Real Change is Generational in Nature

Looking at the past, it appears that healthcare in every generation has gone through a fundamental change. In the sixties, it was the age of insurance - employer and based private, the introduction of Medicare and Medicaid which had profound effects little understood or anticipated. Hill-Burton grants for construction and modern healthcare as we know it was born. Explosive growth little control and we will do things to you and take care of you. You take this pill, have this surgery, do this rehab.

Like parents talking to children, the industry took care of us.

In the 80s and 90s, the introduction of DRGs, managed competition, managed care, HMOs, PPOs, POS and the list goes on. Control of rising costs by attempts to limit utilization and place more burden of cost on the patient. A big change was the introduction of the concept of personal responsibility for your health. Wellness programs became an effort to change lifestyle. A change that is generational in nature for which we are all finally starting to see it pay-off.

Most cost control efforts are still in place today, but have done little in restricting choice and limiting payment having no effect on the continued unabated rise in the cost of healthcare. A failed attempt at meaningful reform and a single government payer system as proposed by the Clinton's in the 90s only added to the dilemma.

Today, HSAs, MSA, higher co-pays, employers dropping coverage and reports that healthcare will top the $4 trillion mark in a few short years. A new call for national health insurance. What we never had until the past few years is the spoken realization that quality pays, individuals have the right to know and that informed decision making based on measured performance against a peer group or nationally recognized care standards is fundamental to controlling utilization and cost.

Medicare will no longer pay for what they consider to be never events. Amazing when you think about it that we as an industry were paid for preventable errors.

Where are we headed?

To the brave new world of price and quality performance data reporting. Informed decision making based on information that is available, free and transparent. Dashboards, report cards, comparisons, call them what you will but it is data reporting none-the-less. This is not a fad, only the beginning of change. Consumers, government and employers being able to make informed choices. Asking a hospital or other provider what there prices are and getting a clean and understandable answer.

Will there be excesses, yes. Its happening already with healthcare organizations using Thompson, Healthgrades, Press Ganey, PRC reports and other reporting companies as evidence that they are better than the competition. Run an advertisement! Yep, that will sure do it. Unfortunately, the use of that medium to report data is not creative in the least and does a disservice to consumers and others, leaving it to the hyperbole of advertising claims.

I do think a clearing house is needed for all of us to sort through the claims, unless of course hospitals and other providers can shift to a more meaningful approach to transparency and quality data reporting than what we are now seeing. It's not about the ad. It's not about the newsletters. It's about doing the right thing this time before other tell the industry how to do it.


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