‘Follow the money’ to reduce cost and improve health care

Regardless of what’s ahead for the ACA, the U.S. must reduce health spending. Dr. Eric B. Larson points to a University of Washington study that reveals how.

by Eric B. Larson, MD, MPH, Group Health Research Institute (GHRI) executive director, and Group Health vice president for research

With the Affordable Care Act (ACA) now under attack, public debate over how to reduce U.S. health care spending has once again reached a fevered pitch. One illuminating view of the problem comes from a comprehensive article published December 27 in the Journal of the American Medical Association: “U.S. Spending on Personal Health Care and Public Health, 1996–2013.”

The study, led by researchers from the University of Washington’s (UW’s) Institute for Health Metrics and Evaluation, found that our nation spends the highest proportion of its health care dollars on chronic conditions, with these categories topping the list:

• diabetes,
• ischemic heart disease,
• low back and neck pain,
• hypertension, and
• injuries from falls.

Taken together, these five areas make up 18 percent of all personal health spending.

So how does our nation effectively address health care cost? We can heed the advice of medical ethicist Ezekiel J. Emanuel, MD, PhD offered in an editorial accompanying the UW study. Follow the money like the UW team did, he writes; their “trail has led to important findings that could ultimately compel the United States to change how it spends its trillions of dollars in health care.”

Dr. Emanuel suggests many strategies included in the ACA and other initiatives — including some pioneered here at Group Health. He points, for example, to a study GHRI and UW researchers conducted on the effects of integrating care for behavioral health problems into primary care practices — an approach subsequently proven to improve care and lower cost. He also touts shared decision making as a way “likely to incentivize increased focus on improving quality, increasing patient satisfaction, and reducing costs,” citing research led by GHRI’s David Arterburn, MD, MPH.

Many at GHRI were proud to see the Institute’s work mentioned in this context, knowing that studies like these are Group Health’s stock-in-trade. I had similar thoughts reading a January 2 New York Times feature story that described ACA-related health reforms that have made a lasting positive impact.

Although not mentioned in the story, work that GHRI’s MacColl Center for Health Care Innovation has successfully pursued nationwide for decades was evident in the writers’ descriptions of chronic illness care improvements. These include:

• the promotion of innovative uses of electronic health records,
• better collaboration among care providers,
• integration of care and coverage, and
• a stronger emphasis on prevention and addressing social determinants of health.

Our Institute has also worked on a variety of “learning health care system” projects within Group Health over the years that have led to a deeper understanding of what it means to provide a “patient-centered medical home” — one that can lead to better continuity of care, resulting in fewer visits to emergency departments and fewer hospitalizations.

As Dr. Emanuel writes, findings from the UW cost study “reemphasize the need for a health care system focused not on acute problems, but rather on the management of chronic, lifelong conditions.” His summary of the work ahead includes

• improvements in prevention and treatment of chronic pain, tobacco use, and mental health problems;
• the promotion of better care for the elderly in nursing homes; and
• promotion of healthier lifestyles to control hypertension and high cholesterol, stroke, and diabetes.

These are all areas where GHRI has excelled in the past and will continue to excel in the future — especially as we become part of Kaiser Permanente’s network of eight regional research institutes nationwide following its upcoming acquisition of Group Health.

Obviously, much work is still needed to reduce health costs nationwide. The rate of increase has slowed in recent years — perhaps in part because of the ACA. But U.S. health spending is continuing to increase at unsustainable levels. Whether or not the ACA is repealed in coming weeks, our work to reduce cost and improve care is as critical as ever to our citizens’ physical and economic well being. GHRI and its research partners will continue to play a crucial role.

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