America’s healthcare system has become too complex and costly to continue in its current state, according to a new report from the Institute of Medicine.
Inefficiencies, an overwhelming amount of data and other economic and quality barriers hinder progress in improving health and threaten the nation’s economic stability and global competitiveness, according to the report.
However, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better-quality care at lower cost.
Among the core system-wide changes the healthcare system should undergo, according to the committee:
• Clinicians and patients should have real-time access to medical records and use technology to streamline administrative tasks.
• Prompts, technologies and delivery systems should help clinicians manage the growing complexity of medical knowledge and care required.
• Hospitals and providers should constantly assess performance and learn from experience to reduce errors and harm.
• Patients and clinicians should have easy access to the prices of tests and procedures and to reliable information about care outcomes and quality.
• Clinicians and hospital staff should communicate to provide seamless, coordinated care within and across different care settings.
• Clinicians should fully incorporate the needs and preferences of patients into care decisions.
• Money should not be spent on unnecessary administration, inefficiencies and care that does not improve health.
The stakes
The committee calculated that about 30% of healthcare spending in 2009, roughly $750 billion, was wasted on unnecessary services, excessive administrative costs, fraud and other problems. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best-performing state.
Incremental upgrades and changes by individual hospitals or providers will not suffice, the committee stated. Achieving higher-quality care at lower cost will require an across-the-board commitment to transform the U.S. healthcare system into a "learning system" that continuously improves by systematically capturing and broadly disseminating lessons from every care experience and new research discovery.
It will necessitate embracing new technologies to collect and tap clinical data at the point of care, engaging patients and their families as partners and establishing greater teamwork and transparency within healthcare organizations. Also, incentives and payment systems should emphasize the value and outcomes of care.
"The threat to Americans’ health and economic security are clear and compelling, and it’s time to get all hands on deck," committee chairman Mark D. Smith, president and CEO, California HealthCare Foundation, Oakland, said in a news release. "Our healthcare system lags in its ability to adapt, affordably meet patients’ needs and consistently achieve better outcomes.
"But we have the know-how and technology to make substantial improvement on costs and quality. Our report offers the vision and road map to create a learning healthcare system that will provide higher quality and greater value."
Problems and solutions
The ways healthcare providers currently train, practice and learn new information cannot keep pace with the flood of research discoveries and technological advances, the committee wrote. How healthcare organizations approach care delivery and how providers are paid for their services often lead to inefficiencies and lower effectiveness, and may hinder improvement.
Better use of data is a critical element of a continuously improving health system, the committee stated. About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions and dangerous drug interactions.
Healthcare professionals and patients frequently lack relevant and useful information at the point of care where decisions are made. New breakthroughs may not gain widespread adoption for years. For example, the use of beta blockers did not become standard practice for 13 years after they were shown to improve myocardial infarction survival rates, the committee wrote.
Mobile technologies and electronic health records offer significant potential to capture and share health data better. The National Coordinator for Health Information Technology, IT developers and standard-setting organizations should ensure that these systems are robust and interoperable, the committee wrote. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care.
Healthcare costs have increased at a greater rate than the economy as a whole for 31 of the past 40 years. Most payment systems emphasize volume over quality and value by reimbursing providers for individual procedures and tests rather than paying a flat rate or reimbursing based on patients’ outcomes, the report states. The committee calls on health economists, researchers, professional societies and insurance providers to work together on ways to measure quality performance and design new payment models and incentives that reward high-value care.
Although engaging patients and their families in care decisions and management of their conditions leads to better outcomes and can reduce costs, such participation remains limited, the committee found. To facilitate these interactions, healthcare organizations should embrace new tools to gather and assess patients’ perspectives and use the information to improve delivery of care. Healthcare product developers should create tools that assist people in managing their health and communicating with their providers.
Increased transparency about the costs and outcomes of care also boosts opportunities to learn and improve and should be a hallmark of institutions’ organizational cultures, the committee said. Linking providers’ performances to patient outcomes and measuring performance against internal and external benchmarks allows organizations to enhance their quality and become better stewards of limited resources. In addition, managers should make sure their institutions foster teamwork, staff empowerment and open communication.
To read an online version of the report, which was sponsored by the Blue Shield of California Foundation, Charina Endowment Fund and Robert Wood Johnson Foundation: http://books.nap.edu/openbook.php?record_id=13444.
To see a PDF breaking down the committee’s recommendations: http://iom.edu/~/media/Files/Report%20Files/2012/Best-Care/Best%20Care%20at%20Lower%20Cost_Recs.pdf.
Inefficiencies, an overwhelming amount of data and other economic and quality barriers hinder progress in improving health and threaten the nation’s economic stability and global competitiveness, according to the report.
However, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better-quality care at lower cost.
Among the core system-wide changes the healthcare system should undergo, according to the committee:
• Clinicians and patients should have real-time access to medical records and use technology to streamline administrative tasks.
• Prompts, technologies and delivery systems should help clinicians manage the growing complexity of medical knowledge and care required.
• Hospitals and providers should constantly assess performance and learn from experience to reduce errors and harm.
• Patients and clinicians should have easy access to the prices of tests and procedures and to reliable information about care outcomes and quality.
• Clinicians and hospital staff should communicate to provide seamless, coordinated care within and across different care settings.
• Clinicians should fully incorporate the needs and preferences of patients into care decisions.
• Money should not be spent on unnecessary administration, inefficiencies and care that does not improve health.
The stakes
The committee calculated that about 30% of healthcare spending in 2009, roughly $750 billion, was wasted on unnecessary services, excessive administrative costs, fraud and other problems. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best-performing state.
Incremental upgrades and changes by individual hospitals or providers will not suffice, the committee stated. Achieving higher-quality care at lower cost will require an across-the-board commitment to transform the U.S. healthcare system into a "learning system" that continuously improves by systematically capturing and broadly disseminating lessons from every care experience and new research discovery.
It will necessitate embracing new technologies to collect and tap clinical data at the point of care, engaging patients and their families as partners and establishing greater teamwork and transparency within healthcare organizations. Also, incentives and payment systems should emphasize the value and outcomes of care.
"The threat to Americans’ health and economic security are clear and compelling, and it’s time to get all hands on deck," committee chairman Mark D. Smith, president and CEO, California HealthCare Foundation, Oakland, said in a news release. "Our healthcare system lags in its ability to adapt, affordably meet patients’ needs and consistently achieve better outcomes.
"But we have the know-how and technology to make substantial improvement on costs and quality. Our report offers the vision and road map to create a learning healthcare system that will provide higher quality and greater value."
Problems and solutions
The ways healthcare providers currently train, practice and learn new information cannot keep pace with the flood of research discoveries and technological advances, the committee wrote. How healthcare organizations approach care delivery and how providers are paid for their services often lead to inefficiencies and lower effectiveness, and may hinder improvement.
Better use of data is a critical element of a continuously improving health system, the committee stated. About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions and dangerous drug interactions.
Healthcare professionals and patients frequently lack relevant and useful information at the point of care where decisions are made. New breakthroughs may not gain widespread adoption for years. For example, the use of beta blockers did not become standard practice for 13 years after they were shown to improve myocardial infarction survival rates, the committee wrote.
Mobile technologies and electronic health records offer significant potential to capture and share health data better. The National Coordinator for Health Information Technology, IT developers and standard-setting organizations should ensure that these systems are robust and interoperable, the committee wrote. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care.
Healthcare costs have increased at a greater rate than the economy as a whole for 31 of the past 40 years. Most payment systems emphasize volume over quality and value by reimbursing providers for individual procedures and tests rather than paying a flat rate or reimbursing based on patients’ outcomes, the report states. The committee calls on health economists, researchers, professional societies and insurance providers to work together on ways to measure quality performance and design new payment models and incentives that reward high-value care.
Although engaging patients and their families in care decisions and management of their conditions leads to better outcomes and can reduce costs, such participation remains limited, the committee found. To facilitate these interactions, healthcare organizations should embrace new tools to gather and assess patients’ perspectives and use the information to improve delivery of care. Healthcare product developers should create tools that assist people in managing their health and communicating with their providers.
Increased transparency about the costs and outcomes of care also boosts opportunities to learn and improve and should be a hallmark of institutions’ organizational cultures, the committee said. Linking providers’ performances to patient outcomes and measuring performance against internal and external benchmarks allows organizations to enhance their quality and become better stewards of limited resources. In addition, managers should make sure their institutions foster teamwork, staff empowerment and open communication.
To read an online version of the report, which was sponsored by the Blue Shield of California Foundation, Charina Endowment Fund and Robert Wood Johnson Foundation: http://books.nap.edu/openbook.php?record_id=13444.
To see a PDF breaking down the committee’s recommendations: http://iom.edu/~/media/Files/Report%20Files/2012/Best-Care/Best%20Care%20at%20Lower%20Cost_Recs.pdf.
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