Five Ways to Bring Down Health Care Costs

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The Robert Wood Johnson Foundation (RWJF) recently solicited opinions from 18 physicians with a diverse range of experiences and specialties to share their ideas on what’s needed to control health care costs.

By 2021, U.S. health care spending is estimated to reach $4.8 trillion.  There is a critical need to slow and control the growth of health care costs and there are many opinions on how to achieve this.

After months of conversation, the RWJF Physician Network on Health Care Costs distilled their insights and perspectives into five consensus themes and recommendations:

  1. Payment models must be evidence-based, physician-endorsed and thoroughly tested.
  2. Protecting and creating financial incentives is critical to broad physician buy-in.
  3. Meaningful consumer engagement requires better communication and guidance from physicians, more willingness from consumers and greater investments in prevention.
  4. Improving quality and reducing cost requires a stronger health information technology infrastructure.
  5. Major changes in education and practice are needed to help reduce costs.

Although I differ in my opinion on “physician-endorsed” payment models, overall I see these recommendations as fundamental principles of the new health care system.

Developing a sustainable payment model that values quality (outcomes) instead of quantity (fee for service) and incentivizes performance will change the way all health care services are designed and delivered, including mental health.

Consumer and family engagement should drive the encounters between patients/clients and members of the treatment team, thus shifting the paradigm from provider care to patient care. HIT, sharing of patient records between providers, will be integral to achieve effective, coordinated care.

And yes, training! Training for all professionals in “team-based care” where the patient is a key stakeholder and partner in their care, along with the physician, behavioral health consultant, nurse, care manager and all members that comprise the treatment team. Treatment protocols are important but we must not forget that people are human beings and that ten persons (or a hundred for that matter) with depression will present differently regarding the symptoms they display, but importantly, each person has their own unique story, life experience, support systems and access to resources. “Patient care” is about the patient, as opposed to “provider care” driven by the practitioner.

Should these recommendations come to fruition (or at the least become fundamental principles), it will then be possible to truly transform the health care system to one that 1) produces robust health outcomes, 2) results in patients more satisfied with their health care, and 3) a system that delivers health care for less costs. There it is again: The Triple Aim.  I can see it now…

One thought on “Five Ways to Bring Down Health Care Costs

    John Young, LPC, LMFT, LCSW said:
    October 25, 2013 at 11:39 am

    “Evidence based” or “outcome based”? Outcome measured how? “Evidence based” treatments are normed on specific populations (usually specified in terms of age, gender, and ethnicity but less usually in terms of, say, income, education, food security, etc). Are they still evidence based when used with diverse populations?

    Evidence supported?
    Evidence informed?
    Evidence hopeful?

    Also, evidence based treatments are usually diagnosis specific. Are they still evidence based when used with individuals suffering from multiple conditions (for example, a heart disease + a neurodevelopmental disorder + a depressive disorder + homelessness)?

    And when it comes to mental health, a diagnosis is required for billing purposes (for establishing “medical necessity”) — and usually for research purposes as well. What if the available diagnostic labels are fuzzy and are forever being debated, modified and/or renamed? See “Epistemological pluralism and scientific development: an Argument against authoritative nosologies” Kristian E Markon, Journal of Personality Disorders 27(5), 554-579, 2013.

    Oh my, what are we to do?

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