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Scott Armstrong
Scott Armstrong

Quality lessons

Patient-centered care vital to outcomes, cost


By Scott Armstrong
Posted: November 15, 2010 - 12:01 am ET
Tags:

Heated discussions rage over rising costs and the lack of access to affordable care. Medical professionals argue about whether we should pay for prevention or just procedures. Accusations fly about how changes to the way medical care is delivered could lead to socialism.

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While it may sound a lot like the great American healthcare debates of the past few years, what I'm actually referring to is the turbulent time in 1946 when Group Health Cooperative, the Seattle-based healthcare organization I lead, was created.

Back then, the nation was recovering from a long war, and hundreds of thousands of men and women were struggling to find affordable medical care. In response, a small group of idealistic men and women launched a noble experiment to create a healthcare organization with a clear mission—to serve the greatest number of people with the best possible care.

They believed that by integrating payment and care in a single group that paid doctors a salary to focus on prevention as well as treatment, they could offer medical care that cost less and delivered better outcomes.

This was a radical approach in 1946 that not everyone agreed with. The local medical society blacklisted our doctors. And yes, the American Medical Association denounced our system as the beginnings of socialized medicine.

Now, 64 years later, there is a growing recognition that integrated, prevention-based care is the key to delivering the affordable, high-quality care that all Americans are searching for.

Increasingly, policymakers and leaders from other healthcare organizations are asking Group Health to share some of the lessons we have learned over the past 64 years.

So what have we learned?

First and foremost, we've learned that great care is patient-centered care. We know that the most important decisions people make about their health happen outside the doctor's office. Patient-centered care provides a way for physicians to engage patients as active participants in every aspect of their health. Patient-centered care also provides the framework for creating integrated group practices where teams of people—doctors, nurses, specialists and patients—work together to achieve the best possible outcomes. And it ensures doctors are accountable to patients for positive results rather than to insurance companies for billing codes.

This leads to a second critical lesson: How you pay for healthcare makes a huge difference. Changing incentives so doctors are rewarded not for the number of procedures they perform but instead for the health of their patients is an essential step to creating a system where affordable, quality care is achievable.

We've also learned that evidence is essential. We know if we don't measure our work carefully and consistently, we can never know how effective we are. So we constantly examine the care we provide to understand where we are making progress and discover where there is room for continued improvement.

By constantly measuring what we do, we also are beginning to collect a body of evidence that strongly indicates we are on the right track in many important ways. For example, hospital readmission rates for Medicare patients across the country hover around 20%. Group Health has lowered that number to 14% during the past year, and our rate continues to fall. As a result, we save about $50 million each year in unnecessary hospital costs. And changes to our enhanced primary-care system are enabling our patients to avoid unnecessary emergency visits and hospital admissions. This is helping us save more than $40 million a year.

There's one final lesson that is important: We will never have all the answers. There is always room for improvement and innovation. Around the country, there are exciting experiments underway to find new ways to organize, deliver and pay for healthcare.

If we can keep an open mind, learn from the successes—and failures—of our colleagues in other organizations, and continue to focus on what works best for patients, I believe we will find the answers we are looking for.

Scott Armstrong is president and CEO of Group Health Cooperative, Seattle.

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