Across the Country, Some Systems Are Getting It Right
July 02, 2009
By Newt Gingrich
Originally Published in the Washington Post
One of the biggest components missing in the current health debate is health. We must ensure that health is always the driving focus of any reform effort. We at the Center for Health Transformation call this "health-based health reform." To accomplish this, we must determine what is actually working today to save lives and save money and then design public policy to encourage widespread adoption. We need to make best practice the minimum practice. Two examples:
More than 20 percent of all Medicare spending occurs in the last two months of life. Gundersen Lutheran Health System in La Crosse, Wisconsin has developed a successful end-of-life, best practice that combines: 1) community-wide advance care planning, where 90 percent of patients have advance directives; 2) hospice and palliative care; and 3) coordination of services through an electronic medical record. The Gundersen approach empowers patients and families to control and direct their care. The Dartmouth Health Atlas has documented that Gundersen delivers care at a 30 percent lower rate than the national average ($18,359 versus $25,860). If Gundersen's approach was used to care for the approximately 4.5 million Medicare beneficiaries who die every year, Medicare could save more than $33 billion a year.
Another example. If the 5,500 hospitals in the country provided care at the level of Intermountain Healthcare in Utah or the Mayo Clinic in Minnesota, Medicare alone would save 32 percent of total spending every year -- with better health outcomes, according to the Dartmouth Atlas of Healthcare.
I give President Obama high marks for his recent letter to Sens. Max Baucus and Edward M. Kennedy which noted that health reform must entail more than insurance coverage. He stressed the importance of finding what works and then creating incentives for its widespread adoption. What he needs to do is put specific policies behind his words.
We propose creating a private-sector led best-practice initiative that educates the industry on documented practices that work. This initiative should support the development and diffusion of knowledge for the purposes of expanding care, improving outcomes, and lowering costs -- with the explicit prohibition that government cannot use the data to ration care. Government health programs should reward organizations that adopt these best practices through higher reimbursements.
Migrating everyone to what works will truly transform the delivery of care.
