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Dr. Reed Tuckson
Dr. Reed Tuckson

The future of healthcare: Payers

Confronting modernity's ills: We must commit to actions that make the healthcare system truly modern

By Dr. Reed Tuckson
Posted: July 25, 2011 - 12:01 am ET

Since this is Modern Healthcare, it is worth posing the question: What makes our healthcare system modern? Most of us think of “modern” as being innovative, better, improved—which is the case in many aspects of healthcare in America today.

However, from my vantage point as chief medical officer for one of the largest health benefits and health services companies in the U.S., too much of what defines our healthcare system as “modern” is, in fact, highly problematic and incomplete in its focus.

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We should worry that our modern healthcare is characterized by ordinary people who find the rising costs of healthcare increasingly challenging to their personal budgets … by small-business owners who are choosing either to stay in business or pay for health benefits … by corporations that find it increasingly difficult to compete in today's global economy … by public servants who are responsible for making Medicare and Medicaid programs work within severely challenged budgets … by my fellow physicians, other health professionals and hospital administrators, who are dedicated to their missions, deserve and need more support, and whose jobs are only going to get harder in the future … by people's quality of life increasingly compromised… by a medical-care delivery system that delivers suboptimal care, yet one we can ill afford.

We should be especially concerned by our nation's inability to adequately address the community-based causes of disease and the persistence of unhealthy, individual lifestyle choices and behavior, which result in disease burdens that compromise individual health and whose subsequent care is increasingly unaffordable.

We also should worry that, as our system becomes even more “modern” through the inevitable advances in molecular science, pharmaceuticals and medical technology, our already-challenged delivery system is in great danger of becoming more complex, inefficient and more costly.

The solution for modernity's ills is not nostalgia for some golden age of care in this country. It didn't exist. Fortunately, there are some basic changes we can make that will improve the quality and affordability of care.

We must get serious about data-driven, local communitywide health planning that sets priorities and employs evidence-based, cost-effective interventions to their solutions. Because state and local government budgets are exhausted, all available private, philanthropic and community-based organization resources must be recruited and coordinated to meet the unique needs of each community. Failure here will have dire consequences.

We need to more vigorously encourage individual responsibility for health through the innovative use of technology and personalized information that identifies what each person needs, and determines how best to target and engage that person through communication channels that fit his or her lifestyle. Healthcare needs to rapidly catch up with other more advanced consumer-oriented industries.

In other industries, technology reduces costs; too often in healthcare, it spins costs upward. So we must identify, incentivize and responsibly manage the introduction of innovations in technology that take costs out by moving care from the most expensive settings—the ER, intensive-care units and hospitals—to outpatient and home environments. Related, we must do better at evaluating the contribution of new interventions relative to existing treatments from a quality and total cost perspective.

Essential to making healthcare choices that enhance quality and cost-effective outcomes is to more rapidly advance the data, science, methodologies and tools essential for continuous health system learning and that are required to assess delivery system and health professional performance. Greater availability and more convenient and timely access to “actionable intelligence” are essential. So, too, is getting to a standardized set of performance measures that can be administered efficiently, continuously enhanced and that are immediately useful in improving affordability in care delivery.

This is a big agenda, but we can't solve the problems challenging healthcare's future one piece at a time. We have to do it all, and it has to be done now. No one health plan or sector of the industry can do it alone—we must all be in this together. Federal and state governments, employers, physicians and other professionals, hospitals and other institutions, pharma and technology companies, health plans and the public at large must dedicate themselves to working more collaboratively and with greater focus on our shared priorities.

We at UnitedHealth Group remain committed to making the necessary investments and engaging in collaborative actions that:

Provide actionable data, planning support and interventions that facilitate local community disease prevention efforts

More effectively support personalized health and wellness choices and behaviors through the application of new data, innovative engagement tools and new health-benefit designs

More rapidly advance the conduct of comparative effectiveness research on high-priority targets and then incorporate that knowledge into care-delivery choices

Advance the development of expert physician-derived performance measures, robust measurement processes and industrywide standardization

Effectively align reimbursement with accountability for optimal quality and cost outcomes

Reduce administrative waste in every aspect of care delivery

Implementing these and other necessary changes—making our healthcare system truly modern—is an enormous challenge involving all aspects of society. But I am energized and made optimistic by the extraordinary talent and capabilities throughout our national health infrastructure and the possibilities for innovation in addressing our challenges.

Dr. Reed Tuckson is executive vice president and chief medical officer of UnitedHealth Group.

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