Glenn Steele Jr., president and CEO of Geisinger Health System, described how his system uses detailed patient care data to attack “unjustified variation” in care and drive down costs through standardized delivery at the system's three hospitals and dozens of clinics across central and northeastern Pennsylvania. Those savings were one way that the system justifies its sizable EHR spending, which consumes more than 4% of its $2.2 billion in annual revenue.
Though Steele was constrained from talking about exact figures (because a certain unnamed medical journal on America's East Coast was still reviewing the data), he said the system had made “dramatic” reductions in rehospitalizations and chronic patient care costs by implementing an advanced concierge service for chronic patients and embedding nurses from its payer programs in its offices.
But since the average size of an American hospital is less than 100 beds, one audience member asked how smaller, non-integrated hospitals and systems could make some of those kinds of wholesale changes. Samuel Nussbaum, the executive vice president and chief medical officer of WellPoint, offered an observation that smaller providers could use “virtual integration through connectivity and health IT” to achieve some of the same results.
Nussbaum was in fairly hostile territory, representing the nation's largest private payer by membership to an audience of health providers. He jokingly said he is sometimes grateful that the tobacco industry absorbs so much public discontent that might otherwise flow to other industries that are “not always loved.”
(Another speaker later in the day, journalist T.R. Reid, asserted that health insurers add an extra 20% in overhead costs to every healthcare bill they pay without offering satisfactory explanations, which he said was amazing considering that the government of France—not known for efficiency—added just 3.1% in administrative costs in its national health plan.)
However Nussbaum did not hesitate to pose some tough and timely questions of his own to the providers in the audience: Why do the nation's best hospitals show a three-fold variation in the average cost of care in the last six months of life? Why do national data on cardiac patients show little if any correlation between cost and quality of care? Why do providers use $100,000 proton beam therapy for prostate cancer treatment when there is no clinical empirical evidence it works better than the $40,000 treatment?
WellPoint has such keen interest in driving some of those answers that it has partnered with the X-Prize Foundation to award $10 million to the person who can come up with a payment system that best improves the value of care.
“In my book, proton beam therapy that doesn't make a difference in care is not innovation,” healthcare futurist and summit emcee Ian Morrison opined in one of his several post-session summary talks.
And then in the manner of a football fan getting an update on the big game during a family picnic, summit-goers watched as Richard Pollack, AHA's executive vice president for advocacy and public policy, appeared on the same screen Sebelius had just six hours before to deliver the news: “Healthcare reform legislation now looks like it's not going to be done any time soon,” he said, via webcam.
One person in the audience clapped.
In an interview in the press room after Pollack's announcement, Umbdenstock said he was not surprised to learn that Congress was balking at President Barack Obama's “aggressive” time table for passage of healthcare reform legislation.
But was the delay a good thing for the industry? “I think it's a good thing not to rush something of this consequence. An extra 30 days, 60 days, isn't too much,” the AHA president said. “I do think this year is the year to pass something that puts us on the road to reform.”
Pollack, in his disembodied address, had made a more conservative bet for the timing of final reform legislation: Dec. 23.
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