Get serious on healthcare costs (Kara Odom Walker)

Dr. Walker heads the DE Department of Health and Social Services, and she has an appealing message. By benchmarking healthcare costs, we can come up with ways to slow the rise of healthcare costs and improve healthcare services for Delawareans. Her approach was showcased in a slew of articles last fall, including a column coauthored with Governor John Carney that was published on 9/7/17A. More recently, it was cited in a 1/28/18 editorial advocating that Delaware "show restraint" about increasing state spending. Now here's a new column, which one might expect to elaborate on this concept and the progress in "some of the most important work that we are doing at the state." Most Delawareans have healthcare insurance, says the writer, but it often features high deductibles, rising premiums, and increased co-pays. As a result, "a growing number of us are paying a larger percentage of our healthcare costs directly out of our pockets, leaving all of us worried when we see rising bills for medications, doctor visits, common procedures or hospitalizations." Benchmarking can help us do better. Calculate total cost of healthcare in DE (be careful, there is a 3-year lag in the federal CMMS data) - track it year by year - compare to economic growth - set a target rate - "measure all of our healthcare spending against that rate." Consider where the money is going, e.g., "are we spending more in nursing home care? Are costs higher for visits to the emergency room or hospital use? Are we spending enough on preventive care?" With this information, one should be able to peel back the layers of healthcare costs - understand our overall spending (regardless of who is paying the bills) for the various categories of healthcare services - "get the transparency we need in order to know where our healthcare dollars are going." The ultimate goal is to scrap the fee for services model and create a value-based healthcare system. "We would pay for optimal health[care] and give the system the flexibility to invest in care coordination, the integration of behavioral health with primary care, and prevention as ways to deliver a healthier population." Kaiser Permanente [CA), Intermountain Healthcare (UT) & Geisenger Healthcare (PA) "have figured out how to provide valued-based care and better overall health to the people they serve," and "so can we." Prior healthcare reform efforts based on "pay for performance" or "quality alone" have fallen short. DE hospitals are working in an "accountable care organization" (ACO) structure, but they need "o pivot from the entry-level version to the "taking on full risk for the healthcare of Delaware" version. Then ACOs will be able to direct their future, with "flexibility [as] to where and how they root out waste and inefficiency," and thus "create Delaware's next generation of healthcare unlike any other place in the nation." To learn more about the benchmark movement in DE, see Patients, caregivers, doctors, nurses, hospitals, employers, and providers [anyone not in one of the other categories?] must all "work together to find opportunities to eliminate waste and reduce unnecessary [who decides?] care. Otherwise, warns the CMMS, "Delaware healthcare spending could double by 2025." More and more of us could find ourselves "priced out of meeting even the most basic healthcare needs for ourselves and our families." Who benchmarks the costs of food, housing, transportation, education, entertainment, etc., and if the answer is no one, why is healthcare any different? Also, where is the evidence that a top-down healthcare system will work unless there is de facto rationing to achieve cost reduction goals?
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