Health Care 2014: Where Do We Go from Here?

This week, many of us will sit around Thanksgiving tables, giving thanks for our families and friends, food and shelter, and living in this good land. We might also say, this land where we have access to some of the best health care on earth.

So how interesting that we have spent the last several years waging war on every part of health care—the building of it, buying it, paying for it, measuring its value and delivering it. How did we get here? Have we lost trust in health care as we’ve lost trust in government?

Or, perhaps there is something more positive at work. That health and health care are so precious that every drop needs to be conserved, like energy. If that’s the story, there really is no win-lose game possible between payers (government, health plans, employers) and providers, or between providers and patients. We all had better win, because what’s at risk is too important.

So how do we do that? While we continue to prod, push and pull health care, we can keep these things in mind:

• Keep a focus on patients. While we are undergoing an unprecedented consolidation of our health care institutions and practitioners, we can measure improvement of patient outcomes and not just report results. We can make measures of good care and efficiency patient-centric rather than provider-centric, and build patient engagement and communication into our enterprises.
• Recognize that individualization is often required to produce results. As we economize care by eliminating wide swings in costs and resources per diagnosis or procedure, we must delve into root causes. Focusing on means and standard deviations alone will only allow us to shrink variation without improving care. Our measurement systems need to be more complex and enable us to ask “why.”
• Include both patients and providers in outcomes measurement. We brand providers as excessive and patients as non-compliant. Human health care is complex because humans are complex. The only way we will improve outcomes is to research what is working, using more comprehensive data—from all parties—culled from all that data collected by our new systems.

One of my forebears, the Lord Governor Thomas Mayhew, once thought this land so wild and untamable that he sold off Nantucket Island and Martha’s Vineyard for a bolt of silk and two bonnets. He never understood their true value (much to my family’s chagrin). Let’s be thankful we so appreciate our health care that we won’t sell it off this cheap!

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Image Credit: Frans Snyders [Flemish, 1579 – 1657], with figures attributed to Jan Boeckhorst [German, about 1604 – 1668], Kitchen Still Life with a Maid and Young Boy, Flemish, mid-17th century, Oil on canvas; The Getty Open Content Program.