Better Health Care at Lower Costs

Why Health Care Reform Will Drive Better Models of Health Care Delivery

Report from Ellen-Marie Whelan and Lesley Russell on why health care reform will drive better models of health care delivery.

A chest x-ray appears on a portable computer outside a room at Children's Hospital in Pittsburgh, Pennsylvania. (AP/Keith Srakocic)
A chest x-ray appears on a portable computer outside a room at Children's Hospital in Pittsburgh, Pennsylvania. (AP/Keith Srakocic)

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Doris Jones is a 70-year-old senior citizen with multiple health conditions, including diabetes, high blood pressure, heart problems, and arthritis. Doris struggles to manage these chronic conditions, which are exacerbated by her poor diet, immobility, and the cost of her medications.

Fortunately Doris receives her care at a very good primary care practice that boasts a variety of health care systems in place to help coordinate all her healthcare needs. The practice has a specially trained nurse, called a “care coordinator,” who makes sure Doris’ weight, blood pressure, blood glucose, and cholesterol are routinely measured, and a diabetes educator who gives Doris nutrition advice and helped her get a new monitor to check her blood sugar levels with a large screen to accommodate her failing eyesight. Doris’s medical records are kept electronically, which means that all her regular blood tests and the MRI scan she’s had to assess her kidney function are shared with all her doctors, eliminating the need for each doctor to order the same tests.

All of these points of coordinated care—regular checkups, health advice, and care coordination—keep Doris in control of her health (see box). But critical to the national debate over health care reform, her coordinated care saves her time, travel, and money. Medicare also saves money because there are no duplicated or unnecessary services.

A key aim of health care reform is to bring better quality and more affordable health care to all Americans. Many people fear that less expensive health care means fewer services, but in health care more is not always better and sometimes is actually worse.1 Doris belongs to a health care system that helps people stay healthy through better preventive services, advice, and guidance on physical and mental well-being, and regular screenings and checkups. The system also recognizes the difficulty many older, chronically ill patients may have in managing their treatment regimes, and provides assistance with this. Doris’s primary care physician, her other doctors and care providers, her hospital, and her community-based services are all connected to ensure seamless care delivery and effective communication.

The good news is that Doris doesn’t live in a yet-to-be-realized ideal world. Remarkably, these gold-standard health care practice patterns not only deliver better patient care and better health outcomes, but also have the potential to save the U.S. health care system billions of dollars every year if they become the models for health care reform nationwide.

There are many ways to decrease the cost of health care while ensuring quality care and there are many examples of this underway in the United States right now. These new approaches:

  • Reduce the waste and duplication when every doctor a patient sees orders the same tests
  • Limit the chances of medical errors
  • Prevent hospital admissions and hospital-acquired infections

Too many patients do not get all the care they need because our nation’s current health care system is fragmented and hard to navigate. That means they are increasingly likely to end up in the emergency department or hospital needing expensive treatment for conditions that could have been prevented.

This paper describes a number of innovative models of care delivery that are currently delivering the dual goals of providing better health care and better value, and outlines the key elements of these new approaches to health care delivery and financing that should be part of the reform of the health care system.

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