If you’re looking for a little optimism when it comes to the future of healthcare in the US, T.R. Reid’s new documentary that aired last night on PBS is a great way to spend an hour. US Health Care: The Good News is all about communities across the country that are providing excellent healthcare, finding ways to provide care for those without health insurance, and doing it all at a cost that is well below the national average.
Grand Junction, Colorado featured heavily in the program. Grand Junction has been a focus of healthcare economists, researchers and politicians ever since it came into the national spotlight as a shining example of a community where doctors, hospitals and insurers are working together to maximize quality of care and access to care, while also keeping costs well below average. Several doctors from Grand Junction are interviewed in the program, and all of them talk about keeping a focus on what will best serve the community and how they collaborate with each other. They also discuss their reimbursement system that involves pooling money from private health insurance (Rocky Mountain Health Plans was a pioneer in the Grand Junction healthcare system four decades ago), Medicare and Medicaid. Then doctors are paid a set amount for each service, regardless of which insurer the patient has. In addition, the doctors have agreed to set aside a percentage of the payments to be used as year-end bonuses based on patient outcomes – so they have an extra incentive to provide outstanding care.
In addition to highlighting the collaboration between doctors, hospitals and insurers in Grand Junction, the documentary also describes programs that the doctors in Grand Junctions have created to provide care for people with no health insurance. B4 Babies provides prenatal care for women who would otherwise not receive it all (and thus helps to prevent premature births and the expensive complications that can go along with not receiving prenatal care). And the Marillac Clinic in Grand Junction has been providing medical, dental and vision care to uninsured residents for nearly 25 years.
After spending a good chunk of the documentary describing all of the great things that are going on in Grand Junction, Reid visited several other communities across the country, pointing out examples of ways that healthcare providers are bringing down costs – while providing care that is as good as, or even better than, care in places with double the costs.
Although there were many different strategies, there were some common themes. Electronic medical records were a must. In every hospital and clinic featured on the show, electronic medical records and computerized ordering/prescribing systems played a part in the success of the program. All were using electronic medical records for their patients health history data. Other examples of healthcare IT included providing virtual healthcare via phone and email (in a clinic where doctors are paid on salary rather than per visit, so they are being paid to answer email as well as see patients face to face), electronic prescription writing, and utilizing pop-up questions to verify that an imaging scan is indicated when doctors place a computerized order for scans (the doctor can override the recommendation of the computer system, but the questions cut down dramatically on the number of high costs tests being done).
Another over-arching theme was a commitment on the part of doctors, hospitals and insurers to focus on what’s best for the community. In all cases, that seemed to be the highest priority – everything else stemmed from that.
Overutilization – driven by supply rather than demand – was another common theme in the program. Basically, that the more healthcare supply we have (eg, scanning machines), the more utilization we have. This accounts for a large part of the huge variation in healthcare costs from one city to another. And in all of the hospitals and medical practices featured on the program, curbing over-utilization and un-necessary spending has been a high priority. One hospital figured out that blood transfusions during surgery aren’t nearly as necessary as they once thought (and indeed, the patients often do better without them). Given that the total cost of blood transfusions is about $1000/pint (!), that’s quite a cost-saving discovery. In another large clinic, pharmaceutical reps were no longer allowed to visit and they also removed the samples of brand name drugs that once filled their drawers. This was a controversial move, but they analyzed a lot of data provided by their local Blue Cross insurance carrier and found that they could optimize pharmaceutical care for a lot less money – patients had better outcomes and the clinic reduced overall Rx spending by $88/million a year compared with the state average.
The Program also showed and example of how patient-centered medical homes work in the real world. PCMHs are a huge buzz word these days, but the PBS documentary shows one in action, and they did a great job of making it easy for patients to visualize how such a program would work and how it would benefit us – including things like much more face time with doctors, and a reduction in the number of hospitalizations and ER visits. In addition to PCMHs, shared decision making between doctors and patients (another buzz word in healthcare reform) was highlighted as having a positive impact on both utilization and patient satisfaction.
Hopefully this documentary will provide motivation and ideas for communities all across the country that are looking for ways to bring down their healthcare costs and provide high quality healthcare to the entire community. It will take some creative thinking along with a commitment to the greater good, but Reid’s documentary proves that it’s very possible – and it’s working well in lots of places.
