Regenstrief Center for Healthcare Engineering

Healthcare delivery part of national healthcare reform discussions

August 4, 2009

Last month, leaders from healthcare industry groups ­representing physicians, insurers, and more, met with President Obama about healthcare reform. From the American Medical Association to leading insurers, the message was the same: “We need to reform the delivery of care.”

This according to attendee George Halvorson, CEO of Kaiser Permanente, who said that by focusing on costs, the media has missed a significant part of the discussion that talks about “significant opportunities to improve care.” The answer isn’t rationing, he said. It’s improving the healthcare delivery system.

“The real opportunity is that 75 percent of costs in America come from people with chronic conditions.” Diabetes, which accounts for 32 percent of Medicare expenses, is the leading cause of blindness, amputations, and other health problems. “If you look at the care delivery patterns of America, we only get care right for diabetics eight percent of the time. If we got care right for diabetics 80 percent of the time, we’d cut the number of kidney failures in half,” he said.

Coordinating care

Halvorson cited tight HIPAA regulations, lack of universal coverage, and a lack of information infrastructure as roadblocks to coordinating care. Care registries or databases have been included in reform discussions as well as research priority lists.

"For asthma care, we wait till the kid ends up in the emergency room, then we don’t tell the primary care that their patient was in the ER with medication failure," he said.

He placed some of the onus on payors to know about coordination tools, such as existing care registries that enable what he calls “virtual integration,” and to insist that providers use them.

Delivering comparative effectiveness research

The Department of Health and Human Services (HHS) and the Institute of Medicine (IOM) issued recommendations for how to use the $1.8 billion in stimulus money designated for comparative effectiveness research (CER). According to both reports, dissemination and adoption of best practices remains a key issue.

"Despite important efforts ... the majority of current funding goes to building evidence as opposed to ensuring that the existing evidence base is utilized in patient care and health systems management," the HHS report states.

The reports also recommend funding registries and establishing data infrastructures. In categorizing its 100 priorities, the IOM report listed more priorities as “healthcare delivery” than any other category.

-- This story was excerpted from the Summer 2009 issue of the RCHE Newsletter --

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