Costs of Health Care in the United States

This article comes from my local Minneapolis news station and I thought it was very interesting. With the state of the U.S. economy right now, I thought that this was an important piece to share with you and wonder what your thoughts are.  Also, I've highlighted a part which I found particularly interesting regarding the Mayo Clinics CEO, Denis Cortese, and where he would like to be treated if he is ever diagnosed with a difficult disease.

This is part two of what will be a three part segment which can all be found here at this web address:

http://www.kare11.com/news/specials/health_care/default.aspx

Before reading this though, I also suggest that you read or watch the video from part one, which leads up to this story.  There are plenty of other resources and articles linked to this series which are also great reads.

"Health Care: Utah clinic gets it right

The cost of health care in America today is at an all-time high. And it's getting more expensive - faster - than it ever has before.

If you average out the price, across the nation, the average family of four is spending more than $28,000 a year on health care. That's more than they're spending on their house.

There are many Minnesota groups, including Mayo, trying to improve the healthcare system here at home and around the country. They say nobody has it figured out 100-percent, but they're clearly impressed with a group of clinics and hospitals known as "Intermountain Healthcare" in Utah.

The folks at Mayo have focused on Intermountain, in part, because they were among the first in the nation to develop electronic medical records and use the information collected to not only improve the quality of their care, but to reduce costs dramatically.

They've become so accomplished with some measures, in fact, that Mayo's Chief Executive Officer Denis Cortese has told his staff, should he ever be diagnosed with diabetes, for instance, he should be sent to Utah for treatment.

EMR: Electronic Medical Records

Intermountain first developed use of Electronic Medical Records in the 1970s. True pioneers, many of the major health groups in Minnesota didn't start putting EMRs into place until the last decade and many clinics throughout the nation still don't do it.

What the folks at Intermountain have shown is that beyond 'convenience' (getting your health information easily from doctor to doctor) those records are a gold mine for helping doctors understand what medical practices best help their patients.

While the rest of the country is just getting up and running with these systems, guys like Jack Whalen who got the ball rolling in Salt Lake City is nearing retirement. He first used EMRs to improve health care for diabetics.

He says results for patients were all over the map at the time, and the cost of their care was very expensive. Whalen says they focused on diabetes early because, "It was pretty obvious that it wasn't cared for as well as it might be."

Tracking patient health by computer, Whalen's group could figure out what treatments were working best. Intermountain got the rest of the doctors in their group to replicate what worked and patient health improved.

In the last couple years they've seen the cost for this care start to rise. But the program's current director, Minnesota native and Mayo educated Dr. Steven Towner, says that's due, in part, to the fact these patients are living longer.

"You could say the costs are cheaper if you let the patient die," Towner told us. "But that's not really what it's about."

How it's Done

Here's how they put the patient records to work:

First, they select the condition they want to focus on.

Then, they make sure everybody with that condition, diabetes, for instance, is in the system.

They monitor the results of their care and they figure out what therapies are working best.

Then, they send out a protocol - these "best practices" become their "science."

They will go way beyond principle doctors, to involve complete health teams in the process.

Even the patients become engaged. The computer records are used in a way that helps them remember what they need to do and when.

Kelly Stanford has been a patient at Intermountain as long as she can remember. She says it's hard not to stay in-synch with her diabetes care.

She's watched her mother age, with the same diagnosis, but without the benefit of the carefully managed care. "If she would have had the same kind of care and follow-up," Kelly says, "maybe she wouldn't even have the problems she's having now."

The Researcher

The goal at Intermountain was always to make patients healthier. What doctors didn't expect was that the cost would drop so much.

In Utah, the cost of health has grown just half as fast as it has nationally. According to the group's research director, Dr. Brent James, "more and more people are coming to understand the key issue is controlling the cost of care, through better care."

He also credits the records focus with helping to build a better, bigger team. "It's like you suddenly just raise the light level and the physicians and nurses involved can see what's happening," says Dr. James.

Beyond Diabetes

They've taken their work well beyond the reach of diabetes. Dr. James is particularly proud of their results in cardiac care.

When they standardized drug therapy for heart patients, he says, the first thing that happened was that far more doctors began to use the right drugs. The next thing that happened: 455 lives a year were saved. And patient re-admissions, for complications, dropped by nearly 900 a year.

"Compared to ten years ago, people who would have died are not dying," says Dr. James. "People who would have lived in pain are not living in pain. That's the best thing. The second thing is that at Intermountain, we extracted hundreds of millions of dollars out of the cost of care."

James says his group literally borrowed a page from "quality improvement" at Toyota, the car company.

Thirty years ago, Toyota figured out how "improved quality" could reduce cost. When asked why it's taken so long for medicine to get up to speed with car manufacturers, in terms of quality controls, Dr. James says, "It's not that we're bad, it's just that when you compare us to our theoretic potential there's this huge gap."

Dr. James says that compared to any other generation, and any nation in the world, medicine in the states is still the best the world has ever seen. "It's not a failure," he says, "except to grasp the biggest opportunity."

Moving Forward

They're still focused on closing that gap today.

It hasn't come without pain.

When they lost the 900 heart patient re-admissions, because they were getting better care on the first visit, there was a serious drop in revenue at Intermountain.

Dr. James says the hospitals should never have been paid for those re-admissions in the first place. They were preventable.

It's getting easier though, because effective this year, Medicare is refusing to pay for such preventable complications in any hospital. Dr. James calls that a "massive incentive not to have complications."

He believes the "Intermountains" & the "Mayos" of the world are well positioned for this change. But some health care systems may fail altogether as the public begins to focus more and more on "getting it right the first time.""

 By Rick Kupchella, KARE 11 News www.kare11.com