Achieving Better Value for Money in Health Care


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Employers leverage their power in labor markets where workers have limited job options to extract higher deductibles and out-of-pocket payments from employees. Unions, which now represent a tiny share of American workers, resist to the extent they can. The numbers spell out the sorry result. Meanwhile, health care outcomes for the population as a whole are improving at a rate far slower than premiums are increasing. This continuing transfer from wages to health care does not reflect better value for money.

What are we doing to ensure the sustainability of the health system?

To get on to the pathway to lower total costs with better outcomes like the parties involved in the mid-Atlantic region are trying to do, players in other regions must understand that they are in a common system with a common pool of limited resources and that separate, zero-sum strategies are destructive.

With that in mind, they must seek four changes.

Each should be measured, reported transparently, and tracked over time. The metrics of per capita cost should include health care premiums paid directly by the wage earner and indirectly by the employer from the compensation pool as well as payroll taxes to support Medicare. Goals should include a mutually agreed distribution of the risks and benefits of cost reduction among all actors.

Lack of transparency stifles competition based on real value and encourages leveraging strategies.

Michael Porter on Paving the Way for Value-Based Health Care

Shared measurement systems and unprecedented and complete transparency about costs and outcomes will help build trust among former adversaries. Key to trust is an agreement in advance on consequences when cost and outcome goals are not met. This is hard work and failure will happen; therefore, it is essential to test ideas on a small scale and increase the scope of the system change as trust builds and we gain confidence.

All actors will need to develop business plans compatible with the agreed premium-reduction goal to allow everyone to succeed in a system that costs less. Such plans may include revenue enhancement by attracting more patients or members from competitors; sharing savings; increasing productivity through care redesign that allows more people to be helped with the same resources; and contributing to non-health-care jobs and economic development to sustain or grow the pool of commercially insured patients.

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Both competition and cooperation can help but only if each is used where appropriate. Cooperation should dominate in goal setting, administrative simplification, measurement and transparent reporting of costs and outcomes, community-based prevention, public education, learning systems for care innovation, and planning of elements of care for which it is technically best to have only one supplier. If costs and outcomes are transparent, competition among some clinical specialists, chronic-disease-care managers, and highly specialized services may be a good thing. But in the many communities that have and need only one dominant health care system anchored by a hospital, it is far better for the players in the region to focus on improving the design of the overall system and reducing premiums through cooperation than attracting new unneeded specialty and tertiary care providers to enter the market.

To make this work, it will take external pressure from employers and unions in the region to keep the health system focused on the Triple Aim. It is only fair that the new system not only provide better care at lower cost but also return the money saved to those from whom it came. E-mail us at healtheditors hbr. Like this presentation? Why not share! Transforming quality and costs at H Embed Size px.

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The Big Barrier to High-Value Health Care: Destructive Self-Interest

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Achieving Better Value for Money in Health Care Achieving Better Value for Money in Health Care
Achieving Better Value for Money in Health Care Achieving Better Value for Money in Health Care
Achieving Better Value for Money in Health Care Achieving Better Value for Money in Health Care
Achieving Better Value for Money in Health Care Achieving Better Value for Money in Health Care
Achieving Better Value for Money in Health Care Achieving Better Value for Money in Health Care
Achieving Better Value for Money in Health Care Achieving Better Value for Money in Health Care
Achieving Better Value for Money in Health Care Achieving Better Value for Money in Health Care

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