Redesigning the healthcare system
around these attributes will not be easy. In fact, it
will require changes at every level, including:
- Environments such as insurers, purchasers and regulators;
- Organizations such as hospitals and medical groups;
- Micro-environments such as office practices and
- Individual clinicians;
- And at the center, the patient.
To meet the STEEEP challenge, some
key changes must begin with purchasers and insurers.
In one major recommendation, the IOM said payments
for care should be redesigned to encourage providers
to make positive changes to their care processes. Ideally,
this shift will begin with purchasers and insurers,
and filter down through the delivery system to help
encourage improvements at all levels.
In response to this challenge,
a group of employers, physicians, health plans and patients
has come together to create Bridges to Excellence. Guided
by three principles, its purpose is to create programs
that will realign everyone's incentives around
- Reengineering care processes to reduce mistakes
will require investments, for which purchasers should
- Significant reductions in defects (misuse, underuse,
overuse) will reduce the waste and inefficiencies
in the health care system today;
- Increased accountability and quality improvements
will be encouraged by the release of comparative provider
performance data, delivered to consumers in a compelling
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Two programs guided by these principles are already
underway: Diabetes Care Link and Physician Office Link.
Diabetes Care Link enables physicians to achieve one-year
or three-year recognition for high performance in diabetes
care. Qualifying physicians receive a $100 bonus for
each diabetic patient covered by a participating employer
or plan. In addition, the program offers a suite of
products and tools to help diabetics get engaged in
their care, achieve better outcomes, and identify local
physicians that meet the high performance measures.
Overall, based on a number of studies and actuarial
analyses, the program is estimated to generate savings
of $350 per diabetic patient per year, and cost employers
no more than $175 per diabetic patient per year.
Physician Office Link
enables physician office sites to qualify for bonuses
based on their implementation of specific processes
to reduce errors and increase quality. They can earn
up to $55 per year for each patient covered by a participating
employer or plan. In addition, a report card for each
physician office describes its performance on the program
measures, and is made available to the public.
Better quality costs less. The savings are there for
the taking. Purchasers everywhere must work together
to create the mechanisms to reap them.
In an age of rapidly rising health care costs, combined
with little or no system accountability, there is a
greater risk than ever for purchasers, patients and
providers to find their interests at odds. This can
lead to intractable gridlock and the creation of few,
if any, solutions to systemic problems.
Taking the steps now
to encourage better performance and reduce inefficiencies
will erase this gridlock and pave the way for a better
system of care -- one that meets the goals of purchasers,
providers and patients alike. Implementing systems to
support physicians is a great place to start. We hope
you will join us in this effort.