Health care reform is more than ensuring more people can get medical services. A large chunk of reform supports ways to improve the quality of these services. This means taking a look at the way services are delivered and paid for.
Phoenix's new Healthcare Transformation Institute (HTI) is just a month old but is already supporting several projects that are looking for ways to make health care services better, faster, and less expensive.
The health care delivery system is basically broken--it takes too long to deliver services, it is unsafe, and its costs are out of control, HTI co-founder Lyle Bootman told a Webinar audience sponsored by the Arizona Health-e Connection this morning. Bootman, who is the Dean of the University of Arizona College of Pharmacy, says HTI's role is to be a "'do tank' to make things happen."
Like a think tank, HTI develops strategies that will lower health care costs while strengthening the delivery system. Unlike traditional think tanks, it actively tests its ideas in real-world situations:
- One project in a small rural county focuses on using medical teams to improve the health of patients with diabetes. HTI is working with local doctors, pharmacists, and the county's only hospital to identify patients with diabetes who can be contacted at home by medical staff. These contacts will give patients the chance to speak with medical personnel about any problems or questions they have, and avoid complications that could require a trip to a doctor's office or emergency room (ER).
- Another project uses the medical home concept to identify Medicare patients who are frequent ER visitors and develop care plans for them. This model of care organizes health care teams to work together in caring for individual patients and avoid the ER and hospitalization.
While these solutions have been tried in the past and have shown success, they run into a key problem: Medicare and Medicaid do not pay physicians to keep patients out of hospitals. Their outdated, fee-for-service arrangements pay for hospitalization and outpatient services provided in medical offices. They pay very little for preventive care and do not pay for many services that can be delivered by less expensive staff such as nurse practitioners and physician assistants.
There is an urgent need to change the way these programs reimburse services, Bootman says. Until medical personnel are paid for their efforts to coordinate care and avoid hospitalizing patients, these models will not be adopted on a large-scale basis. The same applies to various e-health initiatives such as switching to electronic medical records and using call centers to "visit" patients home.
For more information, contact the Arizona Health-e Connection at (602) 288-5130.
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