"The healthcare industry looks eerily akin to a bubble economy," says John Toussaint, MD, CEO of the ThedaCare Center for Healthcare Value in Appleton, Wis. and CEO emeritus of ThedaCare. The country spends $2.5 trillion annually on healthcare, which accounts for 18 percent of its GDP. It would be one thing if that spending translated into pristine healthcare across the board. But a recent Commonwealth Fund study reveals that the U.S. — which spends more per capita on healthcare than any other country — does not get a "notably superior" return on that multi-trillion dollar investment. So how can the country's healthcare system hope to curb costs and improve care?
That's the essence of Dr. Toussaint's new book Potent Medicine: The Collaborative Cure for Healthcare. The book is a vehicle to offer suggestions rather than provide sweeping solutions. Dr. Toussaint is the first to admit there aren't any easy solutions to fixing healthcare right now. He says it's most important for physicians, hospitals and systems to begin the path toward achieving a sustainable healthcare system, keeping the patient at the forefront.
Dr. Toussaint focuses on three interdependent components in his book.
1. Delivery of care designed around the patient. "Most care delivery processes today are designed around the physician, hospital and nurse," Dr. Toussaint says, with "everybody living in their own little silo." He advocates for breaking down those silos in order to maximize value in the patient experience. It's in many ways a revolution that turns the industry on its side, creating an experience focused on the patient and not the provider. The transformation also includes changing current payment models that merely provide fees for services physicians order.
"Our payment system is fundamentally flawed," Dr. Toussaint says. "We are paid to do really expensive procedures on patients that may or may not actually help them."
Part of designing care around the patient involves coordinating care, streamlining information flow and reporting results to other physicians who have care for a given patient. Each physician in an integrated model needs to understand the role other specialty physicians play in the care delivery process. And that understanding needs to be communicated to patients — they need to know who is in charge of their care during every stage of it.
Dr. Toussaint says the current line between care coverage is too blurry, which may confuse patients. Those receiving chronic care may have 20 different departments or units they access throughout their care experience. That means patients have "20 vertical silos to maneuver through," Dr. Toussaint says. "Between those silos there are white spaces where patients get gummed up."
Physicians need to be incentivized to collaborate and provide quality care for patients first, before deciding how to divide income, says Dr. Toussaint.
2. Payment for outcomes. The piecemeal payment models many physicians work in promote a do-more culture among many physicians, Dr. Toussaint says.
"We need to design systems that aggressively keep people healthy," he argues.
His vision is to develop payment systems based on the value of the work physicians and other care team members provide, as well as the health outcome of their patients. It's essentially measuring the value of a physician based on quality, not quantity of care.
"We know how to do this but we've never gotten paid to do it," Dr. Toussaint says. "If we got paid to keep people out of the hospital, we'd keep people out of hospitals."
In turn, hospitals that deliver lower cost care at a higher quality will have more business because they are the best at offering care. "All hospitals and physicians are not created equally," Dr. Toussaint says, and the hospitals and health systems that provide the best care will thrive in a pay-for-health outcomes era.
But flaws in the current payment system stem from more than just a reliance on fee-for-service payments. It's equally important to gut waste from health systems and reduce medical errors.
"Every care process we study has more than 10 50 percent waste," Dr. Toussaint says. "When you take the waste out, you reduce the cost. We fundamentally believe there is plenty of money in the system — but we're wasting about half of it."
Cutting costs in the care process might help quell the fear among a minority of physicians entering accountable care organizations concerned they may make less money. Dr. Toussaint says physicians should be able to earn their current income in a pay-for-health outcomes model if healthcare waste is eliminated. Here are eight areas in the healthcare delivery cycle Dr. Toussaint says are especially wasteful; he envisions removing or reducing waste in the following areas:
- Defects
- Waiting time
- Unnecessary motion
- Over production
- Over processing
- Excess transportation of people and materials
- Excess inventory
- Under-utilized talent
3. Transparency of treatment quality and cost. Dr. Toussaint points to the Wisconsin Collaborative for Healthcare Quality as a potential blueprint for healthcare organizations across the nation seeking a way to enhance transparency efforts. The collaborative is a voluntary consortium of health systems, medical groups, hospitals and health plans in Wisconsin that publicly report performance measurement information. The idea is that transparency will hold these organizations accountable and encourage them to make changes to enhance quality of treatment.
"When you publish your dirty laundry, you get better very quickly," Dr. Toussaint says. "It helps you focus your resources on where you are not performing well."
As Dr. Toussaint points out, having a process in place to compare organizations drives behavior change.
Using scientific methods to improve care — measuring quality performance — and integrating preventive care measures and publicly reporting results will help physicians in the long run, Dr. Toussaint argues.
"When you work smarter, the physicians' lives are much better."
Potent Medicine: The Collaborative Cure for Healthcare is available at createvalue.org or on Amazon.
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