Page 15 - Delaware Medical Journal - May/June 2018
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TRANSFORMATION IN HEALTH CARE
to help determine the total cost of health care spending today. This is simply an act of transparency. The benchmark process will not change contracting, or decrease reimbursement rates or a practice’s revenues.
When we start to peel back the layers of spending, we will uncover opportunities to reduce unwarranted variation across the health care system. Some estimates put the waste in our system as high as 30 to 40 percent. At the same time, there is underutilization of preventive and primary care. Think of the improved outcomes if we could cut that waste by opportunity to have additional services and tools that improve health outcomes for your patients.
MYTH: The benchmark will require physicians to spend a lot of time providing reports about their billing.
The Advisory Group is recommending that the tracking of spending in Delaware should come from payer claims. That means there will be no report that not spend additional time providing data to help us measure the total cost of care in our state.
Similarly, quality measures for the quality benchmarks will be selected from those already being reported for various private and public programs. No additional reporting should be needed.
MYTH: Under the benchmark, physicians will be singled out for differences in cost and quality.
The benchmark is focused on total cost of expenditures in the state. The reporting would be at the system level and may be able to look at large organizations, such as Accountable Care Organizations. The reporting could not, with any accuracy, examine individual or small-practice
variation in cost or quality. Differences
at the system level may help show where we can make improvements, leverage technology investments, or focus on prevention and related health outcomes. Deciding what to do with this information will depend on the public and maybe health systems or large practices if they so choose. The voluntary nature of the the state can do with the information and differences in how and when solutions may be developed.
MYTH: Under the quality benchmarks, physicians will be penalized for not meeting targets.
No health care professional will be penalized for not meeting a quality benchmark, just as is the case for the cost benchmarks. The quality benchmarks will allow us — across the health care spectrum in Delaware — to take stock of where we stand. In 2017, Delaware ranked 30th among the states for overall health, according to America’s Health Rankings.1 We can do better. It is said that what
gets measured, gets done. As part of the quality benchmarks, the Advisory Group And from there, we will see what we
can get done to improve the health of the 960,000 Delawareans2 in our state.
MYTH: The ultimate goal of the benchmark is for the state to set rates.
Absolutely not. While our ultimate goal is to move toward value-based health care, the benchmark is focused solely
on information transparency. Rather
than pay for hospital stays, tests, and procedures a la carte — regardless of outcomes for patients — we would pay for optimal health and give the system the the integration of behavioral health with primary care, and prevention as ways to deliver a healthier population overall.
In this movement toward value-based
care, the benchmark is a starting point and will help us coordinate care among doctors, use data analytics to predict future needs, focus on the least healthy among us, and let doctors share in the reform. The benchmark will be a start
to this conversation, but other strategies can and should come from the health care First, let’s focus more timely information on cost.
REALITY: Despite the myth-buster responses I have provided, I know many of you have concerns. Our goal of making cost growth more sustainable while improving health outcomes will take participation and input from everyone. Physicians, nurses, hospitals, providers, insurers, patients, caregivers, and employers all will need to work together to get better patient outcomes, to reduce the growth of health care spending,
and to improve the overall health of Delawareans.
Please send me your comments, questions or concerns at: ourhealthde@state.de.us.
Read more about the benchmark at: www. choosehealthde.com/health-care-spending- benchmark.
Join us at the remaining Health Care Delivery and Cost Advisory Group meetings, or through Facebook Live on the Delaware DHSS Facebook page.
CONTRIBUTING AUTHOR
■ DR. KARA ODOM WALKER, a board-certified family physician, is the Cabinet Secretary for the Department of Health and Social Services.
REFERENCES
1.United Health Foundation America’s Health Rankings Annual Report 2017. www.americashealthrankings.org/learn/ reports/2017-annual-report
2. United States Census Bureau
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