Less shouldn’t cost more.
Research tells us that spending more on health care doesn’t necessarily mean better health. In fact, care and outcomes are often worse.1
Buying health care isn’t as simple as buying coffee. Yet we assume that spending more should result in better care. In the industry’s current fee-for-service payment model, it’s all about quantity. We pay for tests and procedures when someone is sick, but we don't pay physicians based on how well they manage their patient's overall health and well-being. Our industry lost track of the idea that health care should be about improving people’s health.
As we have pointed out in previous articles, being healthy saves money. So much in fact, we’re using the savings from our quality-based approach as an incentive to reward physicians for providing care that improves their patient's health. Which is great, because everyone profits — providers, employers and, of course, members.
We’re moving the model from volume to value. Here’s how:
Quality pays off
In two years of pilot programs, physicians in Colorado were able to reduce emergency room visits by 15% and inpatient stays by 18% (the control group saw increases in both) while improving performance on diabetes quality measures. Overall, return on investiment estimates ranged between 2.5:1 and 4.5:1.2
Change is good. Change for good is even better. Keep an eye out for additional information as we transform the state of health care.
1 Dartmouth Atlas Project, Dartmouth Institute for Health Policy and Clinical Practice
2 Results from <Anthem> PCMH pilot programs in Colorado over a two-year period