National Quality Colloquium

Today’s Managing Health Care Cost Indicator is 80%

I cochaired a mini-summit panel on value-based purchasing at the National Quality Colloquium today, and wanted to share a few elements from talks given by my colleagues.

Trent Haywood, the CMO of VHA and a former CMO of CMS, and Teresa Clark, VP of Social Science for VHA, had a pithy explanation of the market failures of American medicine, which I am paraphrasing here.

  1. We link pay to cost instead of value

  2. We link pay to volume instead of value

  3. We have inadequate signals regarding quality

  4. Consumers don’t share meaningful financial risk for the cost of care.

They pointed out that the combination of high deductible health plans and payment reform built into the Affordable Care Act addresses each of these underlying problems.

Francois de Brantes,  the Executive Director of the Health Care Incentive Institute, gave an overview of Prometheus Payment, and said that the federal government is well on the way to developing open-source episode definitions that would cover 80% of all medical expenses.  That would make episode based payment very viable in the market, and very much more likely to lead to change of clinical practice.   

He concluded that the five critical elements to the success of payment reform are
-        Full CEO engagement
-        Commitment by willing plan AND provider
-        Clean and complete claims and eligibility data
-        EMR systems
-        Sense of urgency

Leslie Curry, a researcher at Yale and RWJ, showed how her team used ‘positive deviance’ to identify approaches that the most-effective hospitals used to achieve lower risk adjusted mortality for heart attack.  She highlighted the importance of culture and leadership in creating systems that provided consistently better (and more valuable) patient care.

Many of the presentations for this conference are available at (pull down under "agenda" on the front page).  I especially recommend the presentation by Marc Roberts of Harvard School of Public Health on the political economy of quality improvement in health care.