Better Health Care for Lower Costs

By Hootsbuddy

Popular Lie: They want to ration health care!

Reasoned Reply: Yesterday's NY Times Op-Ed by Dr. Atul Gawande and three colleagues shows otherwise. In fact, a number of communities scattered all over the country have been identified as places where patients get better care at lower costs with more efficient delivery systems.

...in studying communities all over America, not just a few unusual corners, we have found evidence that more effective, lower-cost care is possible.

To find models of success, we searched among our country�s 306 Hospital Referral Regions, as defined by the Dartmouth Atlas of Health Care, for �positive outliers.� Our criteria were simple: find regions with per capita Medicare costs that are low or markedly declining in rank and where federal measures of quality are above average. In the end, 74 regions passed our test.

So we invited physicians, hospital executives and local leaders from 10 of these regions to a meeting in Washington so they could explain how they do what they do. They came from towns big and small, urban and rural, North and South, East and West. Here�s the list: 

• Asheville, N.C.


• Cedar Rapids, Iowa


• Everett, Wash.


• La Crosse, Wis.


• Portland, Me.


• Richmond, Va.


• Sacramento; Sayre, Pa.


• Temple, Tex.


• Tallahassee, Fla.,

...which, despite not ranking above the 50th percentile in terms of quality, [have] made such great recent strides in both costs and quality that we thought [they] had something to teach us.

If the rest of America could achieve the performances of regions like these, our health care cost crisis would be over. Their quality scores are well above average. Yet they spend more than $1,500 (16 percent) less per Medicare patient than the national average and have a slower real annual growth rate (3 percent versus 3.5 percent nationwide).

This is exciting stuff. Beyond the small handful of illustrations normally cited (Mayo, Geisinger, Cleveland, Kaiser and El Paso) we now have a string of other communties demonstrating the same simple idea. More is not always better. And sometimes more can be not only more expensive but worse as well.

The line that jumped off the page at me was   ...all medicine is local.  That variation on Tip O'Neils famous line should become the mantra of health care reform. All the smart people are in agreement that the challenge of runaway health care costs has no one-size-fits-all remedy. Details are at the link. But the take away fact is simple: This is a conversation about quality, not costs. But we can get more bang for fewer bucks by paying attention to how we spend. 

Maggie Mahar, my tip-off for this piece, concludes...

The House Bill for healthcare reform calls for more Medicare demonstration projects, like this one, that would allow Medicare to experiment with how it pays for care, and how care is delivered. Successful Medicare reforms will, in turn, create a blueprint for the public sector insurance plan that the administration plans to roll out in 2013. As HealthBeat has said from the beginning , Medicare reform will pave the way for national healthcare reform. This is one reason why it is essential that we have a public insurance option that is modeled on a reformed version of Medicare.