Excerpt

To explore the issues and opportunities central to lowering health-care expenditures in the United States, the IOM Roundtable on Value & Science-Driven Health Care convened the four-part series The Healthcare Imperative: Lowering Costs and Improving Outcomes in May, July, September, and December of 2009 at the National Academies in Washington, DC. These meetings were part of the Roundtable’s Learning Health System series. The series aimed to gather stakeholders in a trusted venue to engage the issues and concerns needed to facilitate the development of a health-care system that not only delivers best practices and adds value with each clinical encounter, but adds seamlessly to the knowledge base for health improvement. Motivated by the proposition noted above of reducing per capita health spending in the country by 10 percent within 10 years without compromising health status, quality of care, or innovation, the meeting objectives included: characterizing and discussing the major causes of excess healthcare spending, waste, and inefficiency in the United States; considering the strategies that might reduce per capita health spending in the United States while improving health outcomes; and exploring policy options relevant to those strategies.

Contents

• The National Academies
• Roundtable on Value & Science-Driven Health Care
• Reviewers
• Institute of Medicine Roundtable on Value & Science-Driven Health Care
• Foreword
• Preface
• Synopsis and Overview
  • THE BURDEN OF RISING COST
  • COMMON THEMES
  • WORKSHOP ONE: UNDERSTANDING THE TARGETS
  • WORKSHOP TWO: STRATEGIES THAT WORK
  • WORKSHOP THREE: THE POLICY AGENDA
  • WORKSHOP FOUR: GETTING TO 10 PERCENT
  • NEXT STEPS FOR THE ROUNDTABLE
  • REFERENCES
• I. Excessive Healthcare Costs
  • 1. The Healthcare Imperative
    • INTRODUCTION
    • PROMOTING EFFICIENCY AND REDUCING DISPARITIES IN HEALTH CARE
    • WHY AMERICANS SPEND MORE FOR HEALTH CARE
    • REFERENCES
  • 2. Unnecessary Services
    • INTRODUCTION
    • SAVING MONEY (AND LIVES)
    • REGIONAL INSIGHTS AND U.S. HEALTH CARE SAVINGS
    • OPPORTUNITIES TO REDUCE UNWARRANTED CARE DIFFERENCES
    • REFERENCES
  • 3. Inefficiently Delivered Services
    • INTRODUCTION
    • COSTS OF ERRORS AND INEFFICIENCY IN HOSPITALS
    • COSTS FROM INEFFICIENT USE OF CAREGIVERS
    • COSTS FROM PHYSICIAN OFFICE INEFFICIENCIES
    • LOW-COST HOSPITALS WITH HIGH-QUALITY SCORES
    • COSTS OF UNCOORDINATED CARE
    • REFERENCES
  • 4. Excess Administrative Costs
    • INTRODUCTION
    • EXCESS BILLING AND INSURANCE-RELATED ADMINISTRATIVE COSTS
    • WHAT DOES IT COST PHYSICIAN PRACTICES TO INTERACT WITH PAYERS?
    • COST SAVINGS FROM SIMPLIFYING THE BILLING PROCESS
    • EXCESS HEALTH INSURANCE ADMINISTRATIVE EXPENSES
    • REFERENCES
  • 5. Prices That Are Too High
    • INTRODUCTION
    • PRICE IMPLICATIONS OF HOSPITAL CONSOLIDATION
    • PRESCRIPTION DRUG PRICES
    • DURABLE MEDICAL EQUIPMENT PRICES
    • MARKET PRICING AND THE MEDICARE PROGRAM
    • MEDICAL DEVICE PRICES
    • Conclusion
    • REFERENCES
  • 6. Missed Prevention Opportunities
    • INTRODUCTION
    • THE PRICE PAID FOR NOT PREVENTING DISEASES
    • COST SAVINGS FROM PRIMARY AND SECONDARY PREVENTION
    • TERTIARY PREVENTION AND TREATMENT COSTS
    • REFERENCES
• II. Strategies That Work
  • 7. Strategies That Work
    • INTRODUCTION
    • REVISITING “UNDERSTANDING THE TARGETS”
    • STRATEGIES THAT WORK AND HOW TO GET THERE
    • INTERNATIONAL SUCCESS AT COST CONTAINMENT
    • REFERENCES
  • 8. Knowledge Enhancement
    • INTRODUCTION
    • SUCCESSES WITH COST AND QUALITY
    • THE VALUE OF ELECTRONIC HEALTH RECORDS WITH DECISION SUPPORT
    • COMPARATIVE EFFECTIVENESS RESEARCH
    • ENHANCING CLINICAL DATA AS A KNOWLEDGE UTILITY
    • REFERENCES
  • 9. Care Culture and System Redesign
    • INTRODUCTION
    • COMMUNITY-ENGAGED MODELS OF TEAM CARE
    • USING PRODUCTION SYSTEM METHODS IN MEDICAL PRACTICE: IMPROVING MEDICAL COSTS AND OUTCOMES
    • MANAGING VARIABILITY IN HEALTHCARE DELIVERY
    • COST SAVINGS FROM MANAGING HIGH-RISK PATIENTS
    • HEALTH INFORMATION EXCHANGE AND CARE EFFICIENCY
    • ANTITRUST POLICY IN HEALTH CARE
    • REDUCING SERVICE CAPACITY: EVIDENCE AND POLICY OPTIONS
    • MALPRACTICE REFORM AND HEALTHCARE COSTS
    • REFERENCES
  • 10. Transparency of Cost and Performance
    • INTRODUCTION
    • TRANSPARENCY IN THE COST OF CARE
    • TRANSPARENCY IN COMPARATIVE VALUE OF TREATMENT OPTIONS
    • PROVIDER PRICE AND QUALITY TRANSPARENCY
    • TRANSPARENCY TO IMPROVE THE VALUE OF HOSPITAL CARE
    • HEALTH PLAN TRANSPARENCY
    • REFERENCES
  • 11. Payment and Payer-Based Strategies
    • INTRODUCTION
    • VALUE-BASED PAYMENTS, OUTCOMES, AND COSTS
    • BUNDLED AND FEE-FOR-EPISODE PAYMENTS: AN EXAMPLE
    • EFFECTIVE HEALTH INSURANCE EXCHANGES: AN EXAMPLE
    • VALUE-BASED INSURANCE DESIGNS AND HEALTHCARE SPENDING
    • TIERED-PROVIDER NETWORKS AND VALUE
    • SIMPLIFYING ADMINISTRATIVE COMPLEXITY
    • TECHNOLOGY AND SIMPLIFYING HEALTHCARE ADMINISTRATION
    • REFERENCES
  • 12. Community-Based and Transitional Care
    • INTRODUCTION
    • COMMUNITY HEALTH TEAMS: OUTCOMES AND COSTS
    • PALLIATIVE CARE, QUALITY AND COSTS
    • COMMUNITY PREVENTION AND HEALTHCARE COSTS
    • REFERENCES
  • 13. Entrepreneurial Strategies
    • INTRODUCTION
    • DECENTRALIZING HEALTHCARE DELIVERY
    • RETAIL CLINICS AND HEALTHCARE COSTS
    • CARE COORDINATION AND HOME TELEHEALTH (CCHT)
    • REFERENCES
• III. The Policy Agenda
  • 14. The Policy Agenda
    • INTRODUCTION
    • GETTING TO HIGH-PERFORMANCE
    • CBO SCORING: METHODS AND IMPLICATIONS
    • REFERENCES
  • 15. Payments for Value Over Volume
    • INTRODUCTION
    • BUNDLED PAYMENTS: A PRIVATE PAYER PERSPECTIVE
    • MEDICARE AND BUNDLED PAYMENTS
    • BUNDLED PAYMENT: PHYSICIAN ENGAGEMENT ISSUES
    • PATIENT PERSPECTIVE AND PAYMENT REFORM
    • REFERENCES
  • 16. Medically Complex Patients
    • INTRODUCTION
    • PAYMENT POLICIES AND MEDICALLY COMPLEX PATIENTS
    • PALLIATIVE CARE, ACCESS, QUALITY, AND COSTS
    • PAYMENT AND BETTER CARE OF COMPLEX PATIENTS
    • CARE OF PATIENTS WITH MULTIPLE CHRONIC CONDITIONS
    • REFERENCES
  • 17. Delivery System Integration
    • INTRODUCTION
    • PROFILE OF SYSTEM FRAGMENTATION
    • PAYMENTS TO PROMOTE DELIVERY SYSTEM INTEGRATION
    • PAYMENT REFORM TO PROMOTE INTEGRATION AND VALUE
    • HEALTH INFORMATION TECHNOLOGY TO PROMOTE INTEGRATION
    • REFERENCES
  • 18. Delivery System Efficiency
    • INTRODUCTION
    • BETTER USE OF HEALTHCARE PROFESSIONALS
    • TRANSPARENCY AND INFORMED CHOICE
    • REFERENCES
  • 19. Administrative Simplification
    • INTRODUCTION
    • ADMINISTRATIVE SIMPLIFICATION AND PAYER HARMONIZATION
    • PAYER HARMONIZATION ON THE PROVIDER PERSPECTIVE
    • POLICIES TARGETING PAYER HARMONIZATION
    • REFERENCES
  • 20. Consumers-Directed Policies
    • INTRODUCTION
    • CONSUMER VIEWS OF HIGHER-VALUE CARE
    • INSURERS, CONSUMERS, AND HIGHER-VALUE CARE
    • POLICIES SHAPING CONSUMER PREFERENCES ON VALUE
    • REFERENCES
• IV. Getting to 10 Percent
  • 21. Taking Stock: Numbers and Policies
    • OPPORTUNITIES TO GET TO 10 PERCENT
    • A LOOK AT THE NUMBERS
    • OPPORTUNITIES TO GET TO 10 PERCENT
    • POLICY PRIORITIES AND STRATEGIES
    • REFERENCES
  • 22. Getting to 10 Percent: Opportunities and Requirements
    • INTRODUCTION
    • CONSIDERING THE OPPORTUNITIES
    • ADDITIONAL CONSIDERATIONS
    • PARTICIPANT LEADERSHIP RESPONSIBILITIES
    • CONCLUSION
    • REFERENCES
  • 23. Common Themes and Next Steps
    • INTRODUCTION
    • COMMON THEMES
    • REFERENCES
• Appendixes
  • Appendix A. Workshop Discussion Background Paper
  • Appendix B. Workshop Agendas
  • Appendix C. Planning Committee Biographies
  • Appendix D. Speaker Biographies

Suggested citation:

IOM (Institute of Medicine). 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press.

Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.