Communication and collaboration are key to efficient care.
Health-care costs will reach unsustainable levels unless patients, insurers, hospitals, public officials, doctors, and other practitioners learn to act more collaboratively, warns the Iowa Committee for Value in Healthcare.
The committee, a group of health advisers, practitioners, and patient advocates, notes that U.S. health-insurance premiums have gone up 120% since 1999. Furthermore, the United States devotes a greater percentage of its economy to health care than the average for developed nations.
"We have to be more structured in our health-care system," says Thomas Evans, committee member and president of the Iowa Health Care Collaborative. "We have to make sure we are putting our dollars where we get the most benefit."
In July, the committee identified five principles for sustainable health care, all tried successfully in Iowa.
1. Fiscal sustainability. Healthcare systems need to stay cost-conscious. It would help if there were advisory bodies monitoring quality of care and long-term costs and savings to the system.
For example, Iowa's advisory bodies include the Iowa Healthcare Collaborative, a nonprofit partnership that disseminates cost-effective practices through its Lean Learning Communities, Lean Annual Conference, and a Lean Learning Tools page on its Web site. All three teach medical practitioners practical tips for cutting costs and increasing productivity.
2. Innovation through collaboration. Providers, patients, payers, and purchasers should collaborate on new and more efficient practices.
A hospital in Pella, Iowa, used this principle to reduce traffic in and out of its emergency room. In 2002, at the suggestion of an advisory committee, the hospital opened a 24-hour clinic to meet more nonemergency needs after normal business hours.
3. Primary-care transformation. Primary-care doctors, nurses, and assistants would take up a larger role.
Starting in 2007, Iowa health practitioners started new training programs to teach physicians the "medic a l home model," by which primary-care physicians follow patients more intensively. Physicians deploy registries that track patients, their health indicators, and any progress. They also follow up with all patients every few months and regularly coach them on healthy living.
"It's primary care doing more now so that you don't need to do more later," says Evans.
4. Societal commitment to prevention and wellness. Encouraging healthier behavior is a vital step toward achieving better societal health.
Some Iowa businesses now offer employees health screenings, on-site Weight Watchers meetings, benefits plans that offer incentives for practicing more preventive care, and other forms of assistance toward lower-risk behavior.
5. Engaged and responsible health-care consumers. Consumers need to be informed about costs, risks, benefits, and outcomes of procedures. They also need a meaningful role in the decision-making process to select information.
The Iowa Community Advisory Councils, which include representatives of physicians' groups, insurers, hospitals, and consumers groups, convene locally on a regular basis and discuss issues in health practice.
"If providers spent more of their time informing patients of the various options available to them, consumers could make the best decisions for them," says Sara Imhof, committee member and regional director for the health-care reform group Concord Coalition.
The key is to provide not just more care, but more value-conscious care, according to Imhof.
"Looking at value is key - looking at the entire medical experience rather than piecemeal episodes, and paying for the best possible outcomes overall," she says.
- Rick Docksai
Sources: Thom Evans, Iowa Health Care Collaborative, www.ihconline.org.
Commonwealth Fund, www.commonwealth fund.org.