One of the directors of the Menzies Centre is Professor Stephen Leeder was my dean of medicine when I studied at the University of Sydney. I have attended various events by the centre for many years, and it is fair to say that it the peak health policy think tank group in the country.
The forum was hosted by Robert Wells from the Australian National University and was attended by some very interesting and influential folk.
I was asked to talk about my experiences with the US health care system and in particular with ehealth.
The key issues I wanted to emphasise were threefold:
Meaningful Use allows the US system to focus on a common goal for providers of healthcare, providers of systems, payers and patients. Linking the adoption of ehealth technology to the meaningful use criteria, which are predominantly focussed on clinical and population health outcomes. They are staged and attainable, and very importantly widely publicised. The money is tied to their attainment, and while there has possibly been some watering down from the original goals, which demonstrates that the system is responsive, they are still major enhancements to the quality of care and public health for the majority of Americans.
Bending the Curve is a term gaining a lot of airplay in the United States. Whilst the USA has the most expensive care around the world, some reports would suggest that the quality of care that it is not of the highest quality. I referred to a great article by Atul Gawande a couple of years ago called “The Cost Conundrum” where he looked at the heterogeneity of care in the USA. In particular he used as an example MacAllen Texas, a town with the second highest healthcare costs in the country and not particularly impressive health outcomes. Bending the curve relates not just to slowing down the costs of healthcare, but the discrepancy in quality and outcomes of care within a very diverse country. This is an area where ehealth can play a critical role, because it allows the information to be captured and shared effectively. Rather than respond to studies based 5 years in the past, near real-time reporting allows people to focus on bending the curve at a local level quickly. The key learning is that you have to publicise the problem, not just in the medical press, but also to the lay press and to anyone who will listen so that you can bring them along for the journey of healthcare reform.
Accountable Care Organisations, a new concept introduced to the USA recently provide a concrete model that people can deliver to. ACOs are reimbursed for improved efficiency and health outcomes, and are designed to facilitate collaborative care models. But importantly they don’t define in detail how health care providers form their ACOs. This allows for innovation but with some specific focus around the needs. The ACOs have allowed physician and other healthcare provider and payer groups to develop innovative ways of delivering on the need for greater efficiency and quality of care within the current reimbursement models. One way of doing this is providing focussed services to high need populations, leveraging technologies like home monitoring where it makes sense. Again Atul Gawande’s writings in the New Yorker, the article “The Hot Spotters” in the January 2011 edition focuses attention on the need to identify high risk populations and develop solutions for them leads to more efficient effective care. These solutions need to focus on the individuals with the problem, and the population health and cost benefits will accrue.
The USA in undertaking major healthcare reform, and we have watched how messy that has been. In parallel, and thanks to the fact that the ehealth investment is funded by economic stimulus funding rather than funding linked to healthcare reform it is also undergoing a major enhancement in its use of information technology in healthcare. Much is catching up, but there is a lot of underlying innovation, which will affect us worldwide. So it is very important we watch with great interest, and leverage from their investments in Australia and elsewhere.
I would love to hear your thoughts.