Cost is top threat to care quality, and fixing that can repair our broken healthcare system
The $2.7 trillion that America spends on healthcare every year is overshadowing doctors’ ability to provide quality care to patients — but that dark cloud also shines a light on the opportunity, and the need, to better control spending.
“Cost is the number 1 threat to quality in the United States,” said Peggy O’Kane, founder and President of the National Committee for Quality Assurance. “It hurts the ability of doctors to do a good job. We have a lot of high deductibles that stand in the way of getting the kind of primary care and chronic disease management care that people need.”
Joining O’Kane at the NCQA Quality Talks event on Monday in Washington, DC, Maria Gomez, CEO and Founder of Mary’s Center, said that medical care contributes to 10 percent of patients’ overall health, genetics are at 30 percent, social and environmental determinants are 20 percent and some 40 percent depends on individuals’ behavior.
“We know this but we do exactly the inverse,” Gomez said. “We spend 70 percent on the medical piece and maybe 30 percent on creating safe neighborhoods, affordable housing, great schools for everyone, not just specific zip codes.”
Martin Makary, MD, a professor of surgery at Johns Hopkins University School of Medicine, said the appropriateness of care is driving the cost crisis and he cited a national survey that found medical professionals estimated that 21 percent of care is unnecessary.
“That’s the opportunity to fix our broken healthcare system,” Makary said. “We need to find a way to measure it and we need to address it.”
O’Kane said that the healthcare industry needs to embrace continuous quality improvement.
“Three things we have to work on: quality of healthcare, customer service, and the most important and compelling right is now cost,” O’Kane said.
To that end, O’Kane explained that quality is about more than numbers and algorithms and, instead, involves both saving lives and improving quality-of-life for patients.
The customer service piece, otherwise known as patient experience, is no longer a nice-to-have, and O’Kane said that plenty of research and literature exist to show that patients are more receptive and compliant when they feel like they are important in the healthcare system.
And then there’s the massive issue of healthcare costs.
“One way to cut costs is to skinny up the benefits with high deductibles and co-insurance, the other way feels even more draconian and that it is to take coverage away,” O’Kane said. “I personally believe every American should have health insurance. The hard road is cutting costs without compromising quality.”
That will require both technology and kindness, said Lynn Banaszak, the founding executive director of the Disruptive Health Technology Institute.
“We need to keep innovating but we also need to readjust our perspective about being bigger, faster and stronger by adding kindness into the mix,” Banaszak added.
Banaszak cited research that found 75 percent of study participants answered that they would pay more for kinder care and 88 percent are willing to travel farther to receive it.
“Let’s be bigger than an acrimonious healthcare debate that no longer focuses on what matters most: how our healthcare system is treating people every day,” Banaszak said. “Technology and kindness.”
On the technology front, O’Kane added that both EHRs and quality reporting have made life miserable for doctors and we cannot have burned out physicians on the front lines while trying to control costs and improve care quality.
“We all have a noble mission here. We have a lot of work to do to have quality not hated by practitioners,” O’Kane said. “We have to make quality reporting supportive to practitioners, not a burden. We need to persist in this mission of driving continuous quality improvement.”