MGMA Annual Conference, Oct. 11, 2009
By Matthew Vuletich, MGMA senior writer/editor
You don't always get what you pay for, and the U.S. healthcare system might represent the best example of this "anti-axiom."
In the first keynote speech of the MGMA 2009 Annual Conference in Denver, Ezekiel Emanuel, MD, PhD, author and bioethics chair for the National Institutes of Health and senior advisor at the White House Office of Management and Budget on health policy, cited myriad statics showing that while the U.S. healthcare system is the "most expensive in the world," it fails at delivering care comparable to its costs.
"We're spending more [on healthcare] than the Chinese are on everything they spend on personal consumption," Emanuel said. We spent $2.2 trillion on healthcare in 2007 but ranked 50th in the world in life expectancy at birth and 12th at the age of 65. He added that a 2006 Rand Corporation study found that only 55 percent of Americans receive the recommended level of healthcare. Clearly, that $2.2 trillion "is not buying us value," he insisted.
So what would the ideal system look like? Emanuel described it as the "Holy Grail":
The way to get there, he said, is through "High Touch Medicine" – a system that emphasizes coordinated care instead of volume-driven care. It would require significant changes in patient treatment and physician reimbursement.
High Touch Medicine would empower patients through education, shared decision-making and access to care teams that include not just primary care physicians and specialists but also dieticians and lifestyle coaches. Greater online access to care-givers and even house calls would reduce office and emergency room visits, increase compliance with care plans and reduce costs.
While not naming them, Emanuel said several American companies have already implemented models of High Touch Medicine with on-site clinics that:
Employees of these companies have fewer hospital stays, office visits and ER trips, Emanuel said.
Unlike High Touch Medicine, there are no perfect examples of the type of bundled payments needed to create the Holy Grail of medicine, Emanuel noted. Ideally, though, such a payment system would reward physicians for using the highest standards of care to achieve certain markers in patients with chronic conditions such as diabetes. The reimbursement system would be risk-adjusted for co-morbidities and include allowances for avoidable complications.
"I think these changes are going to come," he said. Then he posed a question to MGMA members in attendance: Are you ready to do what's needed in your practices to prepare for these changes?
MGMA 2009 Annual Conference