Organized systems of care deserve attention

By SPENCER R. BERTHELSEN, M.D.

The Obama administration and Congress are promising to reform our nation's health care system. Senate Finance Committee chairman Max Baucus, D-Mont., is correct when he cautions that "the health system is so complex that any solution will demand time and attention to make sure that we get it right." But how exactly do we go about getting it right in making needed corrections to our health care system?

To make progress toward improving quality and containing costs, serious consideration should be given to organized systems of care. An amount of $1.1 billion has been set aside in the $787 billion stimulus bill to evaluate methods of treatment used to treat common illnesses, with a goal of identifying effective treatment pathways based on the standards of evidence-based medicine. But this research effort will fall short unless it considers organized systems of care. While it's not widely recognized, these systems produce better clinical outcomes at a lower overall cost of care. They deserve a closer look.

Organized systems of care include some of the most trusted names in health care, such as The Mayo Clinic, Kaiser-Permanente, the Geisinger Clinic, Scott and White Clinic, Intermountain Healthcare and, locally, Kelsey-Seybold Clinic. They are based on care coordination and use evidence-based care practices with an increasing reliance on the effective use of information technology. Recent studies strongly suggest that these organized systems of care are needed in America:

• The Centers for Medicare and Medicaid Services in August reported the results of its Physician Group Practice Demonstration project - concluding that 10 participating multispecialty physician groups saved Medicare $17.4 million while improving health care outcomes.

• The Dartmouth Institute for Health Policy and Clinical Practice studied end-of-life health care resource utilization, comparing UCLA and Mayo Clinic. UCLA spent more than $93,000 per patient over the last two years of life. The Mayo Clinic, by contrast, spent $53,432, a little more than half the amount of UCLA, on similar patients over the same period of time. Chronically ill patients had more than twice as many physician visits at UCLA compared with Mayo, and they spent almost 50 percent more days in the hospital.

• While there is a general assumption that more medical care means better care, the Dartmouth Atlas research shows that hospitals, regions and states that use more services per patient do not necessarily have higher-quality care. Dartmouth's Dr. Jann Wennberg has called for a crash program to learn how leading organizations, such as Mayo Clinic, use fewer resources and spend less per capita than their peers, while at the same time produce higher scores on quality of care measurements.

• o Medicare's Payment Advisory Commission states that creating incentives to "encourage physicians to form or join high-performing multi-specialty medical groups could achieve more organized systems of care and thereby improve the health care provided to Medicare beneficiaries while reducing costs."

• A recent New York Times report illustrated similar findings by international benefits consulting firm Hewitt Associates. Hewitt concluded that integrated systems such as Kaiser Permanente "provided 22 percent greater cost efficiency than competing systems." A similar Hewitt benchmarking study of health plans in Houston described Kelsey-Seybold's "KelseyCare" health benefits plan as the area's most financially efficient plan. The plan demonstrated comparatively higher-quality measures along with lower overall cost, according to Hewitt.

Fixing the nation's health care system is a daunting task with many complexities to consider. I believe that those involved in the process should take a careful look at what's already working well. Experimentation will be costly and, in the health care field, potentially dangerous. Today, organized systems of care are providing millions of Americans with high quality care at a lower overall medical cost. They deserve to be emulated and reinforced.

Dr. Berthelsen is chairman of the board of directors of Kelsey-Seybold Clinic.