No silver bullet for cost-saving measures in healthcare

“There are no silver bullets,” said Harold Miller, president and CEO of the Network for Regional Healthcare Improvement and executive director for the Center for Healthcare Quality and Payment Reform, during his address to the Maine Medical Association on June 27.

Miller’s sprawling target: the colossal financial barricades riddling the healthcare industry in the United States. With numerous studies trumpeting the setbacks of care quality and outcomes, many physicians, legislators and medical experts have been harried to eliminate tiers of misguided incentives to bring ethics and savings back to the forefront of healthcare.  

These partitions in the healthcare purse are by no means strictly American-made, either. “It’s not just the United States,” Miller said, “every country in the world is struggling with the issue of healthcare costs and what it is doing to their economies and their government.”

“The fascinating thing is that a couple of sector expenditures in the United States are actually pretty much on par with other countries. What is actually way out of line in America is the private sector, in fact, it’s making American industry uncompetitive because of the amount that [employers] are spending on healthcare. What we’ve seen is that businesses have been pushing this down to the employees. Employer contributions to health plans have doubled, while employee contributions have tripled. It’s gotten to the point where everybody is tapped out,” he added.

Throughout the remainder of his seminar, titled “Overcoming the Barriers to Higher-Value Health Care: Successfully Using Payment Reform and Data to Improve Quality and Lower Cost,” Miller noted that the agents of change when it comes to reforming healthcare spending practices are not the legislative bodies, but the medical bodies — the physicians who care for their patients day in and day out. Yet despite this belief, Miller recognized that physicians are repeatedly paying a toll for their trade, to their trade.

“I concluded a long time ago, if we’re going to make healthcare reform work, we really need the physicians because they are key to healthcare and healthcare change,” he said. “There is no other industry in America where the key employees of that industry are told ‘your salary is going to be cut by 30 percent at the end of the year regardless [of performance].'”

What Miller prescribed to alleviate this inverted practice is what he calls a win-win mentality, where the physicians, the system and the patients all come away with a healthy victory.

The win-win solutions model was broken down by Miller into four sections, as such:

1. Defining the change in care delivery -- How can the physicians, hospital, or other providers change the way care is delivered to reduce costs without harming patients?

2. Analyzing expected costs and savings -- What will there be less of, and how much does that save? What will there be more of, and how much does that cost? Will the savings offset costs on average?And how much variation in costs and savings is likely?

3. Designing a payment model that supports change -- Such a model incorporates flexibility to change the way care is delivered; accountability for costs and quality/outcomes related to care; adequate payment to cover lowest achievable cost; and protection for the provider from insurance risk.

4. Compensating physicians appropriately -- Changing payment to the provider organization (physician practice/group/IPA/ Health system) does not automatically change compensation to physicians.

Miller hailed the necessity for the system to cut costs without rationing care, a three-pronged philosophy bent on the following:

  • Keeping people well.
  • If chronic disease befalls a patient, help him/her manage it in a way that prevents the patient from being hospitalized.
  • If people do need hospitalization, eliminate all the complications, infections and readmissions. Ensure a successful outcome.

This, Miller added “can’t be done from Washington, which is why the solutions that come out of Washington don’t work really well because healthcare is local and must be solved at the local level.”

Thus, the solution to healthcare salvation is not found within one single shell, but multiple casings, all of which must emerge by way of a precise barrel. Miller challenged physicians to take aim as a community, and claim their bounty for themselves, each other and their patients. 


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