Robert Laszewski
Posted 3/08/12 on Health Policy and Marketplace Review
I thought it was worth passing along the comments by Jim Tallon, president of New York’s United Hospital Fund, in a recent post.
Tallon reflected on an international meeting he attended with health care leaders from a number of industrial nations–“nations whose health care systems, indeed underlying philosophies, ranged from market orientation through hybrids to government authority:”
“Across the industrialized world, people are coming up with fresh ideas and vital approaches to the profound, central challenge that health care constitutes—new ideas on organization, financing, and care, on far greater use of real-time information technology, and on patients’ greater engagement in their health…”What were these leaders’ ‘keeps me awake at night’ concerns? Their answer, almost uniformly, was that the pace of innovative change would not overtake the financial imperative to slash spending.
“The challenge within the challenge, then, is how to take individual ideas and models to scale. With considerable consensus on the problems, and individual projects being implemented—whether generated in local communities or institutions or stimulated by government or private-sector support—we are now at a critical juncture: can the ideas that are being tested ultimately alter economic and societal trends, in which health care plays a major role? How do individual ideas, even the sum of those individual ideas, expand into systemic change that ultimately can get us the health care system we need, accessible for all, of the highest quality, and—the biggest challenge—actively altering the constant upward movement of the cost curve?”
We are 30 years into what could generally be described as managed care—all of the attempts to create an affordable quality health care system. But 30 years in, we may have done little more then to blunt our escalating health care costs.
Time is running out. And, not just in the U.S. And, not just in market-based systems.
Care And Cost 
“The challenge within the challenge, then, is how to take individual ideas and models to scale.” This is the key point as there are lots of great innovations taking place. In my view, the ones that have the greatest promise of slaying the cost beast are those focused on primary care. One umbrella organization — the Healthcare Delivery Innovation Alliance (www.hdia.org) — is working the scalability issue. [Disclosure: My company is a member.] Some examples of promising, innovative primary care models include Qliance, WhiteGlove Health, Physician Care Direct, MedLion to name a few.
Perhaps the best example of primary care driven models that are scaling are onsite clinics. Many of them are growing 100% year over year. I’ve heard statistics saying 20% of employers with over 500 employees have or will have an onsite clinic. Employers get the fact that ROI is strongest with expanding primary care access.
Fully agree. I recently visited a full-function municipal primary care clinic and saw firsthand the results which have been achieved. Since I have been advocating for a restructured approach to our health care system based on a primary care cognitive core, operations like these are badly needed on a much larger scale. If we put our system on a steady diet of quality primary care that starts with the basics and extends all the way out to primary care doctors coordinating the delivery of the most expensive care to the best centers of excellence, we could go a long way to correcting the problems attendant to our massive overspending. If primary care doctors have the time to address our comprehensive needs fully, a lot of poorly coordinated excess would disappear. This is the kind of disruptive innovation that needs to happen promptly.