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No Magic Bullet for Health Care Reform

Rarely does a day go by that I don’t run into another article arguing the efficacy of health care reform tactics such as medical homes, Medicare payment reform, and Electronic Health Records (EHR). A recent example is  “Do Electronic Medical Records Save Money?” by the New York Times. The piece reveals the results of a 2008 federal survey showing that physicians using electronic records actually ordered more high cost tests than their peers who were still using paper medical records. This is contrary to the belief that EHR systems have the potential to save costs by reducing the number of tests being ordered. The study also challenges the large investment being made by the Federal government to promote EHR adoption. The question then becomes, does one study that disproves the original hypothesis mean we should stop forward momentum in that area that still has the potential to improve the health care system? Absolutely not. Each study provides another learning opportunity and a chance to get at the root of what it really takes to change a broken system.

What is only alluded to in this particular article, is the positive effects EHR and other innovative delivery models can have on improving the patient experience and cost of health care when an integrated system is developed to incentivize positive changes. This particular study, for example, evaluated independent physicians who had no financial incentive to reduce the number of expensive tests ordered regardless of whether or not it was in the best interest of the patient. Integrated systems like Kaiser Permanente, on the other hand, have been reaping the positive financial and increased quality of care benefits of electronic records for many years. This points to one of CIVHC’s primary beliefs – not one singular solution, whether it is payment reform, EHRs, or medical homes, will solve our health care problems. All of these initiatives and others like them are in and of themselves “necessary, but not sufficient”. There is no magic bullet for health care. It takes a multi-pronged, coordinated approach to reach the triple aim goals of better population health, higher quality care, and lower health care costs.

Colorado is unique in that we have multiple community efforts underway to move the dial on health care metrics and reduce the current delivery system inadequacies. These include medical home programs that enhance the coordination of primary and specialty care, utilizing EHR registries and health information exchange (HIE) to improve chronic care disease management, and projects to reduce hospital readmissions and enhance transitions between care settings. Payment reform efforts are also underway including CIVHC’s bundled payment efforts and the All Payer Claims Database (APCD) which will allow for cost transparency across all major payers covering Colorado’s 4.2 million lives. All of these approaches in Colorado are a continual work in progress, and are constantly being tested, modified and coordinated to ensure they are effective in working towards achieving high value, low cost, exceptional patient care.

I liken fixing our broken health care system to rebuilding New Orleans post-Katrina. It didn’t just take raising money, building new buildings, repairing the utility infrastructure, or fixing the levys to make the city vital again, but the culmination of many community efforts working together towards a common goal. The same is true of our health care system. It’s going to take hard work and multiple initiatives collaborating in tandem to realize improved health care and cost containment.

In my mind, the New York Times article is encouraging because it points to an incredible advancement in health care. For the first time across multiple health care delivery systems, we are finally able to collect and demonstrate meaningful data to identify the high impact opportunities for change. The information we are beginning to be able to collect will help us pull all of the necessary pieces of the puzzle together – integrated care models, payment reform solutions, data transparency, etc. – to show that all of these approaches are necessary and a vital component to achieving our health care goals.
 

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