Thursday, July 17, 2008

2008 Health System Scorecard Shows No Improvement

Alas! The Commonwealth Fund Commission on a High Performance Health System released its first health system scorecard two years ago, and found that the United States fell far short of benchmarks for access, quality, efficiency, and other key measures of health system performance. Now, two years have gone by, and the 2008 edition of the scorecard paints an even bleaker picture. Instead of organizing around change for improvement, supporting the ability of primary care to provide a personal medical home and holding insurance companies accountable to help improve care, congress has gone through their annual dithering about how much to lower doctor rates, insurance plans have continued to cherry pick low risk subscribers, and the number of primary care doctors has continued to dwindle. It is no surprise that we have gone from bad to worse! Our system is perfectly designed to get these results.

The United States scored an average of 65 out of a possible 100 across 37 indicators— below the overall score in the 2006 report, which was already abysmal! The U.S. health system is on the road to a train wreck. Of greatest concern, access to health care has significantly declined. As of 2007, more than 75 million adults—42 percent of all adults ages 19 to 64—were either uninsured during the year or poorly insured, up from 35 percent in 2003. At the same time, the U.S. did not keep pace with gains in health outcomes achieved by the leading countries. The U.S. now ranks last out of 19 countries on a measure of mortality amenable to medical care, falling from 15th as other countries raised the bar on performance. Up to 101,000 fewer people would die prematurely if the U.S. could achieve leading, benchmark country rates.

The U.S. spends twice per person what other major industrialized countries spend on health care, and our costs continue to rise faster than income, while our quality results continue to plummet. We will soon have $1 of every $5 of national income going toward health care. We should expect a better return on this investment. We should be outraged.


Scott Hodson said...

Many American health systems are significantly underinvested in quality management Infrastructure, Process, and Organization. Without a solid quality management strategy, it is irrational to expect quality and outcomes to improve. To develop a "world class" quality management foundation, my firm's perspective is that that as health system must address 5 key factors:

Strategy: including a clear linkage of quality and patient safety to the organizational strategy and a Board-driven imperative to achieve quality goals.

Infrastructure: incorporating effective quality management technology, EMR and physician order entry, evidence based care development tools and methodologies, and quality performance metrics and monitoring technology that enables "real time" information.

Process: including concurrent intervention, the ability to identify key quality performance "gaps," and performance improvement tools and methodologies to effectively eliminate quality issues.

Organization: providing sufficient number and quality of human resources to deliver quality planning and management leadership, adequate informatics management, effective evidence based care and physician order set development, performance improvement activity, and accredition planning to stay "survey ready every day."

Culture: where a passion for quality and patient safety is embedded throughout the delivery system and leaders are incented to achieve aggressive quality improvement goals.

We have assisted a number of progressive health systems to achieve such a foundation, and to develop truly World Class Quality.

Erin said...

Another interesting conversation with an Obama advisor, David Cutler:

It explains the thinking behind the plan Obama is espousing.

I'd appreciate your views on David Cutler and Obama's plan!

David A. Lynch, M.D. said...

I agree completely with the comments of Scott Hodson, and what he describes is exactly what we have been working to achieve in my medical group, Family Care Network.

As far as Erin's comment is concerned, I believe that Senator Obama's "plan" is the closest thing to what we are espousing, and certainly is a much better step forward than Senator McCains idea to let the market solve things by itself. See my next post for an update article on Obama's ideas, and an interview with David Cutler.

Anonymous said...

This article could be of interest to this discussion:

An overview:
Exhibit 1: Health care spending in the United States is far above the expected level, even after adjusting for relative wealth.

Exhibit 2: The United States spends nearly $650 billion more on health care than might be expected, with outpatient care accounting for over two-thirds of this extra spending.

Exhibit 3: Delivering care in an outpatient settings saves $100 billion to $120 billion in inpatient costs­ but reduces above-expected spending on outpatient costs by very little.

Exhibit 4: Same-day hospital care and visits to physicians’ offices contribute the most to the overall growth in spending for outpatient care.

Exhibit 5: Drug prices for comparable products are 50 percent higher in the United States than in other OECD member countries.
Exhibit 6: The US health system’s payment structure has a strong impact on the cost of health administration and insurance.