November 18, 2011


First Respo (Kai Falkenberg, 11.16.11, Forbes Magazine)

The Affordable Care Act, better known as ObamaCare, provides for universal coverage but is proving anything but affordable. Yes, there are billions projected in cost savings from modernizing our health system, but the law provides little framework for getting that done, just lots of money to study it. Meanwhile, Americans will break another record this year, spending 17% of GDP--a chest-grabbing $2.7 trillion--on medical expenses, the highest in the world, all to buy results that are worse, collectively, than most of the industrialized world. You've heard that tune before.

Much of those costs--up to 30%--are unnecessary. (Dartmouth president, Jim Yong Kim) comes from the camp, based on two decades of Dartmouth research, that believes this waste can be eliminated by rewarding health care providers for better patient outcomes rather than more procedures. The trick is navigating a system of dizzying complexity: coordinating treatment across physicians and health systems, using universal medical records to avoid duplicative testing, employing community-based health workers to cut down on hospitalizations and emergency room visits and the like. A riddle far more likely to produce an Excedrin-level headache than any type of results.

But Kim has a tool that can potentially provide answers to the cost issues ObamaCare simply raises. This fall he launched the Center for Health Care Delivery Science. On paper it's a master's program. In reality it's a grand experiment that mixes disciplines (management and systems engineering, economics, insurance, as well as medicine and health policy) and personalities (researchers and practitioners are paired). Four dozen of the best minds in their fields--the average age is 45, and most with two decades of top-flight experience--will meet weekly, usually virtually and sometimes in Hanover, N.H., for the next 18 months to participate in what Kim terms a "fundamental revolution in the way we think about health care." [...]

The faculty and students draw upon groundbreaking research compiled over the last two decades by the Dartmouth Institute for Health Policy & Clinical Practice, a group that has criticized how U.S. medical resources are organized and practiced. It is particularly known for its Altas of Health Care, which produced a map of the U.S. showing the country's distribution of medical resources that has drawn the ire of physicians, hospitals and health officials (see graphic, above). It focuses on end-of-life care, drawing on Medicare claims data, and shows dramatic variation in cost and outcome across the U.S., broken down by region, hospital and illness. Why did expenses rise five times as fast in McAllen, Tex. as they did in Honolulu? Wasteful spending: too many hospital beds and high-priced specialists rewarded for piling on tests and procedures.

The Atlas has provoked debate in the White House and Congress about tying Medicare payments more closely to benchmarks of efficiency. It has also brought howls from high-cost institutions that claim they must spend more because their patients are sicker. They point to a competing University of Pittsburgh study, which found that patients tend to live longer in hospitals that provide lots of expensive end-of-life procedures. Yet in March new analysis by the health arm of the National Academy of Sciences, factoring in variations like cost of living in different regions, largely confirmed the Dartmouth findings.

What the Atlas can't provide are the tools to redress all the inefficiencies. That's the ambitious work of Kim's Center. "Medical school let us down," says Brian Spence, a student in the program and anesthesiologist at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. "They never taught us that medicine was a business. None of the other programs address the central core of health care delivery, of getting the most bang for your buck."

Posted by at November 18, 2011 6:03 AM

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