Value for health care $

[Guest guest]

There is quite a bit of good research on this. Some telling

references are copied below.

The bottom line: countries that invest in primary care achieve better

population health outcomes at lower per capita cost than countries that

do not invest in primary care.

Caveat (issue that must be addressed in the U.S.):

Just spending more on the current primary care delivery system is not

likely to achieve significant improvement or savings.

Most clinicians are interested in delivering excellent care but believe

that they are already doing so, but this assumption is not supported by

data. Numerous careful analyses demonstrate gaps so huge that they

are in aggregate called " the quality chasm. "

What we've been doing in the IMP project:

1: Demonstrating that physicians are willing to engage in serious

quality measurement and improvement (once again)

2: That it is possible to measure and improve even in solo and

small practices

3: That a curriculum and dissemination strategy exist that reach

docs where the live and at a cost that is manageable

4: And that the work results in improved patient experience of care

and clinical outcomes

An overview:

LG, Wasson JH. The Ideal Medical Practice Model:

Maximizing Efficiency, Quality, and the Doctor-Patient

Relationship. Family Practice Management September 2007

pp. 20-24

We have other articles in the pipeline.

We know from the IMP project that the current payment models are

inadequate to the work of excellent primary care. We must move

beyond volume based payment models that inadequately fund the right

work.

We are working with interested payers (and always willing to talk with

new ones!) to explore new payment demonstrations that support excellent

primary care.

I'm also interested in exploring payment models that eliminate all the

administrative nonsense that is wrapped up in E & M coding,

documentation and billing.

Gordon

References:

Bodenheimer, T. Primary care: Will it survive? New England

Journal of Medicine, 335;9 Aug 31, 2006, 861-864

Wasson, J. H., , D. J., , R., , J., &

MacKenzie, T. A. (2006). Patients report positive impacts of

collaborative care. Journal of Ambulatory Care Management,

July-September 2006 29(3), 199–206.

Schoen C., Osborn R., et al. On The Front Lines Of Care: Primary

Care Doctors’ Office Systems, Experiences, And Views In Seven Countries

Country variations in primary care practices indicate opportunities to

learn to improve outcomes and efficiency. Health Affairs Web

Exclusive, Nov. 2, 2006

Fisher ES, Wennberg DE, Stukel TA, et al. The implications of regional

variations in Medicare spending. Part 1: the content, quality, and

accessibility of care. Ann Intern Med.

2003;138:273–287.

Fisher ES, Wennberg DE, Stukel TA, et al. The implications of regional

variations in Medicare spending. Part 2: health outcomes and satisfaction

with care. Ann Intern Med.

2003;138:288–298.

Baicker K. Chandra A. Medicare spending, the physician workforce, and

beneficiaries' quality of care. Health Affairs. Suppl Web

Exclusive:W184-97, 2004.

Zastrow RJ, Quadracci L. Engaging Quad/Graphics Employees in the

Improvement of Their Health and Healthcare Journal of Ambulatory Care

Management, 29(3), 227-231

Angrisano C, Farrell D, Kocher B, Laboissiere M, S.

Accounting for the Cost of Health Care in the United States.

McKinsey Global Institute January 2007

At 04:32 AM 1/8/2008, you wrote:

,

Does anyone know which scheme gives the best value for health

$?