Americans spent roughly $2.9 trillion dollars on healthcare last year, roughly 18 percent of our nation's gross domestic product. By 2022, that figure is expected to rise to 19.9 percent, according to Health Affairs. Without significant spending reductions — which will only come from significant changes to how care is delivered — healthcare in America will become unsustainable.
This call to action is one heard many times throughout the healthcare world, and, in response, organizations across the country are rethinking how they deliver care to reduce their cost structures and eliminate unnecessary or inappropriate care.
Yet, it's not health system or insurance executives who will be key to bringing about these changes. Instead, it's the practicing physicians treating patients each day that hold the power of large-scale change. If each physician in an organization practices evidence-based care, and has access to information that allows him or her to coordinate that care, the savings — not to mention quality improvement — will ripple throughout the organization.
That is exactly the scenario Pittsburgh-based UPMC is working toward. The explosion of medical technology, including devices and drugs, as well as an aging population, has driven up the costs of care over time, says Steven Shapiro, MD, chief medical and scientific officer at UPMC and president of the Physician Services Division.
And while these advances have certainly led to extended and better quality of life for many people, their use must be closely monitored to ensure it's effective in today's value-based world.
Evidence-based care pathways
So how does UPMC monitor care delivery? In addition to physician "report cards" that track patient outcomes and costs for various procedures and conditions, UPMC physicians have developed numerous care pathways intended to help improve adherence to evidence-based medicine.
The care pathways are developed in two ways: For some, system leadership directs efforts to ensure that the most common and costly conditions are having pathways developed for them. In other cases, physicians within a service line have come together to develop a pathway in more of a "grassroots" approach.
UMPC has even commercialized its cancer care pathways, creating subsidiary Via Oncology to market its Web-based cancer pathway solution for oncologists. Dr. Shapiro says a product for pathways within the cardiac suite is also in the works.
These commercialization efforts reflect UPMC's goal of shifting up to a quarter of its revenue from non-traditional sources, or the system's patient care and health plan revenues.
Physicians can no longer ignore cost
While outcomes take highest priority, cost is also a consideration. Care pathways reduce duplication and other unnecessary care caused by a lack of adherence to evidence-based practices.
Encouraging physicians to consider cost of care is critical under value-based care.
"The most subtle, most profound part of healthcare reform is the movement of more cost on to the patient it. You can't avoid talking about cost," says Mr. Shapiro.
Yet, it doesn't always come naturally to physicians, who receive little or no training around cost issues.
While physicians at UPMC aren't expected to know the exact cost of every treatment or drug under multiple health plans, they "can't avoid talking about cost," he says.
Instead, physicians can give patients guidance about who to contact for more specific pricing information, and more importantly, "physicians should be cognizant of unnecessary care," says Mr. Shapiro.
The role of any physician leader today should include educating the medical staff on the importance of cost consciousness. Getting physician alignment around the importance of following evidence-based guidelines to reduce unnecessary care ensures a "unified physician group to march in the same direction," says Dr. Shapiro.
How is your organization aligning physicians toward cost conciousness?