Tuesday, November 12, 2013

Going to the Moon in Health Care

The U.S. health care system needs a new, audacious goal: limit health care expenditure growth to the growth of national economy.

“That is, by the end of the decade, health care costs per person will not grow faster than the economy as a whole,” 
writes Ezekiel J. Emanuel, M.D., Ph.D., of  The Perelman School of Medicine and the Wharton School, University of Pennsylvania, Philadelphia, in a Viewpoint appearing in the November 13 issue of JAMA, a theme issue on critical issues in U.S. health care.

Dr. Emanuel presented the article at a JAMA media briefing at the National Press Club in Washington, D.C.

Dr. Emanuel writes that the health care system is in need of what author Jim Collins, a business strategist, called a big hairy audacious goal (BHAG): by 2020, per capita health care costs will increase no more than gross domestic product (GDP)+0 percent. Collins used the term BHAG “to define a kind of goal, like going to the moon, that can make an organization—or a nation—stretch beyond what it thought was possible to achieve remarkable things.”
“The goal of reining in per capita cost growth is clear and easily measured. It is not going to happen overnight; it is going to take at least until 2020 to achieve. Success is not guaranteed. During the last 50 years, only a few years in the mid 1990s have seen per capita cost growth track closely to the growth of the economy. But by the end of the decade, getting there is possible. Most importantly, if the effort is successful, the entire health care system will have been transformed.”
Dr. Emanuel notes that states have begun to adopt this BHAG.
“In 2012, Massachusetts enacted another important health reform law to improve quality and reduce costs. It had a spending target of limiting health care cost growth to growth of the state economy—the equivalent of GDP+0 percent. Maryland and Arkansas have adopted similar cost-control goals.”
“So what will it take to get to the moon in health care? It will require substantially more focus on delivering care to the 10 percent of patients with chronic illness. It will require turning care delivery upside-down. Instead of focusing on care in the hospital, more outpatient monitoring of these patients, and more interventions at home, are necessary to keep them healthy and with fewer emergency department visits and hospitalizations. To achieve this requires electronic records with real-time tracking of leading physiologic indicators. It requires team-based care coordination between office, hospital, pharmacy, and home. It requires reducing the use of inappropriate interventions. If all this happens, the other goal that everyone believes is critical—improved quality of care—will be achieved.”

Dr. Emanuel concludes that most importantly, the goal of limiting U.S. health care expenditure growth to the growth of the national economy “will organize and focus energies and skills in a way that will permanently transform health care for the better.

Ultimately, President Kennedy may have said it best:
‘"We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win."’
doi:10.l001/jama.2013. 281967

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