Policy Recommendations on Improving the Quality of Health Care in America

The first course of action to improve the quality of care in America should be the establishment of a federal agency under the auspices of both the NIH and Department of Health and Human Services, referred to hereafter as the Center for Quality Health Care Delivery, or the CQHCD.  This institution will lead efforts to reform the health care system by implementing evidence-based medicine, reforms in payment policies, the coordination of care, and health information technology.

Evidence-based medicine can be implemented by setting two priorities: first, bridging the gap between scientific discoveries and clinical practice by making information more accessible to providers, and second, establishing the infrastructure of an Evidence-Based Practices Agency directed by the CQHCD.  Such steps include promoting the automation of patient-specific clinical information and tying this to decision-making that minimizes doubt according to a comprehensive set of standards that attempt to use tangible scientific evidence to best treat each individual.  The government must ensure the accessibility of conveying scientific evidence to both patients and clinicians.  Not only will these efforts increase the yield of positive treatment outcomes, but they will also decrease the possibilities of medical error.  Guidelines of best practices and outcome measures facilitated by HIT can restore a system beset with human mistakes.

Another pivotal measure in improving quality of care includes revamping the method in which clinicians are currently paid for their medical services.  In accordance with the Evidence-Based Practices Agency, all insurance companies must reward providers for acknowledging procedures that have demonstrated efficacy and for administering high quality treatments that result in positive outcomes.  Currently, fee-for-service models reimburse mere complexity, while capitation and DRGs compensate for cost control.  The United States needs to transition towards a system that rewards actual results for the entire medical team, and not just individual clinicians.  Because of this nation-wide realignment of payment policies, providers will have more of a financial-based incentive to act in the interest of achieving better measures in clinical quality, such as cancer screening, immunizations, and management of chronic diseases, as well as raising patient satisfaction and investing in HIT that will promote innovation and data analysis.  Much too often, physicians who make an extra effort to provide coordinated care actually lose income because they include cost-effective preventive treatments, as opposed to doctors who heavily rely on expensive specialist procedures entailing numerous follow-up visits. 

Health care should involve a well-orchestrated team of medical professionals working together in a holistically integrated fashion.  Financial incentives can foster a sense of interdependency among providers to help them coordinate a more patient-centered health delivery system.  This teamwork can be encouraged by bundling payments and sharing reporting and electronic medical records between physician groups and hospitals.  In an attempt to further the patient-centered care model, clinicians must move beyond the historical focus on just treating diseases case-by-case and instead focus on improving health holistically by conducting preventive, acute, and chronic care on all fronts.  This realignment can be approached by having health care organizations pay for episodes of care being attended to rather than for each separate procedure provided.  Utilizing computer-based patient-specific records will increase portability, enhance consistency, and enable the network of physicians participating in a broad number of cases to more effectively communicate with each other.  Relying on HIT for chronic care and disease prevention efforts could result in up to $147 billion in savings per year. [4]

Another priority that must be addressed to simplify consumer navigation of the health care system involves using HIT to increase transparency.  Disseminating information and establishing report cards that measure both quality and satisfaction will empower patients to clearly identify plans best suited for their own needs.  The increased support for health delivery systems will lead to improved quality, lower costs, and easier navigation for patients everywhere.  For example, CABG report cards have lowered mortality rates as much as 41% and influenced hospitals to train extensively in best practices.  The acceptance of quality outcomes will ensure that all providers have a stake in their results and allow managed competition to drive improvements. 

The Center for Quality Health Care Delivery (CQHCD) will play an instrumental role in coordinating many of these newly proposed policies.  For quality of care, the use of evidence-based medicine and payment reform to reward providers for positive outcomes and recommended practices will result in consistency and improved results.  In terms of navigation, the implementation of coordinated care, integration of data via HIT, and dissemination of report cards will foster teamwork among clinicians and increase consumer transparency.  In the long term, lost revenue should be generated from the limitation of medical error, a reduction of waste, and the widespread adoption of evidence-based practices.  Instituting these changes will also harness consumer-driven competition to improve quality in medical practices and empower patients to use reported information during health care navigation.  Although significant hurdles remain, bipartisan directives will transform collaboration, innovation, and standardization into evidence-based and patient-centered practices that make disappointing quality outcomes a relic of the past.

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[1] “Building a New Vision for Health Care in America.”  Mayo Clinic Health Policy Center. Mayo
     Medical Clinic. 21 Dec. 2007.
[2] Feldstein, Paul J. “Health Policy Issues: An Economic Perspective.” 4th ed. Chicago, Illinois:
     Health Administration Press, 2007.  Chapter 19, “The Evolution of Managed Care.”
[3] “Health Care Fact Sheet.” Hillary for President. 21 Dec. 2007.
[4] Hillestad R. et al. 2005. “Can Electronic Medical Record Systems Transform Health Care?
     Potential Health Benefits.” Health Affairs. 24: 1103-1117.
[5] Institute of Medicine. 2001. “Crossing the Quality Chasm: A New Health System for the 21st
     Century.” Report Brief. Washington, D.C.: National Academy Press.
[6] Institute of Medicine.  1999.  “To Err is Human: Building a Safer Health System.” Report Brief. 
     Washington, D.C.: National Academy Press.
[7] RAND. 2005. “Health Information Technology: Can HIT Lower Cost and Improve Quality?”
     Santa Monica, CA: RAND. 21 Dec. 2007.