Higher quality health care at a lower cost: challenging and achievable #ahcj13

Working together in teams and investing in primary care can improve health outcomes and reduce spending in the American health care system, a panel of experts told a packed room at Health Journalism 2013 Friday afternoon.

“You cannot tell me that better care and lower costs don’t go together because I’ve seen it,” said Donald Berwick, former administrator of the Centers for Medicare and Medicaid Services. The best examples come from communities not policymakers, he said during the session entitled, “Controlling health care costs while improving quality.” And they inevitably involve patients, doctors, nurses and other providers working together, he added.

Berwick cited a healthcare project in Alaska, where team-based care has resulted in 50 percent fewer hospital bed days, 53 percent fewer emergency department admissions and 65 percent fewer specialty visits.

Berwick said the fact that the U.S. health care system continues to provide low value at high-cost is a “crisis” and people are scrambling to figure out how to fix it. Among the biggest problems that have led to waste in the health care system are pricing failures, uncoordinated care and unnecessary treatment, Berwick said. “More is not better,” he said. “We are going to have to change the way we think.”

Changing the system from one focused on fee-for-service to one that emphasizes good health outcomes will be a challenge, he said.

Berwick appeared on the panel with Nancy Shendell-Falik, chief nursing officer at Tufts Medical Center, and Reid Blackwelder, president-elect of the American Academy of Family Physicians.

To deliver cost-effective, high-quality care, Shendell-Falik said Tufts has made several changes, including adding support personnel so nurses can work to the top of their licenses. The hospital is also forming partnership with patients and families, she said.

She detailed two areas where the medical center is working to reduce costs and improve care. The first is preventing falls, which are both dangerous and costly. Falls have dropped from 25-30 a month in 2008 to 8-10 in 2012, but the goal is zero, she said. “It takes constant vigilance every single day,” she said, adding that the hospital has also reduced central line infections by standardizing procedures.

She emphasized that changing health care systems doesn’t happen overnight. “This is a journey, not a destination.”

Blackwelder said that managing patients as a team is the key to change. Primary care doctors are a critical part of that team, and the evidence shows that investing in relationships and preventive care can lead to fewer deaths, better detection of disease and reduced health disparities, he said.

“Primary care is about outcomes,” he said.

Innovative programs are occurring around the nation, including in Minnesota, Washington and North Carolina, and people are starting to notice, Blackwelder said. People are talking about primary care and patient-centered medical homes, even if they don’t know exactly what that means.

The speakers urged journalists to tell the stories of programs that work, and to write real stories that raise awareness about the importance of primary care and team-based efforts.

“This story is an untold story,” Berwick said.

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