Policy Forums

Improving Productivity in Health Care
Executive Summary

Michael Stocker, M.D., Wellpoint

Forum II

January 21-23, 2007
Cambridge, Mass.
Slides of final rankings of principles by participants (PDF)
Agenda

Mayo Clinic Health Policy Center convened more than 30 leaders from across the country at Harvard University to discuss how to improve the effectiveness and efficiency of health care in the United States. The meeting was co-hosted by Harvard's Kennedy School of Government Health Care Delivery Policy Program.

The participants recommended a fundamental restructuring of our current delivery and reimbursement systems, with improvements funded by eliminating waste and increasing value. The group reached a common vision for change:

"Every American should have the opportunity to contribute to and benefit from the creation, dissemination and use of health care knowledge. To accomplish this, there must be increased support for health delivery science, which generates new knowledge by using common tools such as information systems, process improvement techniques and outcomes measurement. Multispecialty integrated systems with established networks for knowledge dissemination will be better positioned to incorporate new knowledge that improves care."

Action Principles

At the forum, participants proposed, debated and ranked action principles — broadly agreed-upon fundamentals that will contribute to the formation of public policy and produce positive change. The group envisioned several ways to increase efficiency, effectiveness and value in American health care.

1. Develop a definition of value based upon the needs and preferences of patients, measurable outcomes, safety and service, compared to the cost of care over time.

Participants estimated that a large portion of health care activity doesn't add value to patient care and should be removed from the system. The group strongly recommended that a common value equation — cast from the patient's perspective — be created so that stakeholders could collectively evaluate and improve factors that contribute to the overall care experience. The group also agreed that payment should be based upon episodes of care delivered over longer time periods rather than paying for discrete services.

2. Pay providers based on value and develop a methodology for allocating finite resources.

Participants spent a significant amount of time discussing the perverse payment system, in which incentives are skewed to foster the inefficient, expensive and often inappropriate care that riddles the U.S. health care system today.

Group members strongly endorsed the idea that providers should be paid based upon the value that they offer to patients (as defined in principle #1). Some participants felt that tackling the financing system would be a good first step toward reform because other problems (i.e., overuse of many services and tests) would be resolved if the system paid for value.

3. Create competition around results through pricing and quality transparency.

Transparency and standards of measurement are critical if stakeholders are to make value-based choices. Most forum participants agreed that providers should measure and publicly display their outcomes, patient satisfaction scores and costs at an aggregate level. The group agreed that health care providers must begin to compete on these elements — rather than focusing on cost-shifting and bargaining power — to increase value to the patient.

4. Hold all sectors in health care accountable for reducing waste inefficiencies.

The majority of forum participants endorsed the basic tenet that any proposal for change in health care must demonstrate how it would reduce waste and inefficiencies, not simply shift cost to another sector.

"There has to be recognition that the answer can't be that one sector reduces their cost or responsibilities by shifting duties somewhere else. We can't just keep shifting costs and blame."

–Denis Cortese, M.D., Mayo Clinic

Participants bemoaned the silos — hospitals vs. physicians; insurers vs. providers — that fracture our delivery system, and recommended the difficult task of building agreement and accountability across multiple parties. The group acknowledged that a cultural transformation must occur across entire organizations — from the CEO suite to members of the supply chain — to accomplish this objective.

5. Create a trusted mechanism to synthesize scientific and clinical information in an impartial and rigorous way for both consumers and providers.

Participants acknowledged the deluge of medical information that clinicians and the general public must sort through each day. They recommended creating a group — funded by the government but not influenced by politics — to synthesize and disseminate knowledge that would improve patient care. Some members suggested that, with increased funding, the Agency for Healthcare Research and Quality may be able to fulfill this role.

6. Encourage formation of integrated systems to deliver effective and appropriate care.

"Integration of care through time and space is an essential property of a well-functioning system."
–Don Berwick, M.D., Institute for Healthcare Improvement

Although ample research supports the idea that integrated group practices deliver more efficient, effective care, participants noted
the many failures in trying to start them. Forum members felt that more integrated groups of practicing physicians (not group practices, per se) would emerge if the reimbursement system changed to reward efficiency, coordination and integration.

Forum members also proposed the idea of a "medical home" for patients, a place with resources and infrastructure to organize and coordinate care over a lifetime.

To make these suggested changes would require further consensus-building among stakeholders and a carefully constructed action plan to manage the transition to a new system.

Next Steps

These proposals – along with others developed during the remaining forums will be reviewed at the Mayo Clinic Health Policy Center's 2nd National Symposium on Health Care Reform in 2008. Additional programs — town hall meetings, or summits with national policy and business leaders — will be held to synthesize and further define these principles and build support for comprehensive reform. The ultimate goal is to engage a cross-section of stakeholders and build a public mandate for change based upon common principles.

Divergence Points

Because of time constraints and differing perspectives, several ideas emerged that didn't receive full discussion or endorsement:

• Participants didn't come to consensus on the degree of government control needed to accomplish the recommended changes (i.e., transparency of quality and pricing information).
  
• Group members had different opinions about who should lead change — the government or the private sector.
  
• There was some divergence on the issue of choice — some arguing that too much choice is not a good thing, others arguing that consumers will be able to sort through choices with some education and help from trusted parties.