One of the challenges with a discussion on value-based care is thinking about where to start. Given the country’s trillion-dollar healthcare industry, cost tends to be the first issue that people gravitate to. How do you reduce costs in an industry that is so complex and huge?
In a discussion at the StartUp Health Festival this week, panelists with backgrounds in hospital administration, surgery, pediatric medicine and government shared initiatives they are undertaking to focus on value with the hope that those efforts would reduce costs in the long term.
Dr. Marty Makary, the head of Islet Transplant Surgery at Johns Hopkins Medicine, went to the crux of the matter when he contrasted how the country responds to acute care needs compared with chronic conditions.
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“If you get shot, you want to be in the U.S. and be taken to a great academic trauma center and you will get state-of-the-art care and get your life saved. But if you walk into a hospital with chronic pain, we don’t know what to do with that.”
As it turns out the panel’s name “Obliterating the Cost Curve: Reducing the Cost of Care by a Factor of a Million,” didn’t go over well with some of the panelists. They noted that the cost issue is only one part of the challenge.
Andrey Ostrovsky, the former CMO for the Center for Medicaid and CHIP Services, a division of the CMS, said it had similar undertones to underfunded block grants.
“People dying would decrease costs if we are just focused on costs,” Ostrovsky said dryly.
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Makary highlighted the need to reduce waste by creating better quality measures.
“If you talk to practice doctors they have become alienated from the science of risk adjustment,” Makary said. “We have a crisis of appropriateness in healthcare.”
Makary used the opioid crisis as one example of an area where more appropriate care guidelines and waste reduction were needed.
“We can show where the waste is…but what do we do with that data? Make it public information? Humiliate doctors? Put them in jail?”
He called for a peer-to-peer approach, using opioid prescription data to make physicians aware that they are overprescribing but if they didn’t change their ways, that information should be made public.
Liz Dunne, Peace Health CEO, highlighted three strategies towards addressing the value-cost conundrum. She said her institution has focused on radical cost reductions, reducing its focus on acute care and giving more attention to social determinants of health.
Although Ostrovsky’s background has been in pediatrics, he recently shifted his focus to the opioid epidemic. He emphasized the need to focus on outcomes but acknowledged that hospitals would have to be willing to accept reduced revenue in the short term for greater gains in the long term.
“If we don’t think about outcomes, cutting a safety net that’s already underfunded will kill people,” Ostrovsky said.
Image: mattjiecock, Getty Images
