A “Fix” for Health Care in the U.S.?

December 5, 2013

In contrast to all the turmoil about Obamacare and its roll-out, the most recent issue of Fortune magazine has an article by Becky Quick (p. 66) who reports on Mark Bertolini’s simple three-point prescription to “fix” the U.S. health care system. Bertolini happens to be the chairman, CEO, and president of Aetna, the insurance giant that insures 44 million American lives. He feels his three-point plan can “heal” U.S. health care.

His first step: eliminate fee-for-service and replace it with rewards for good outcomes. He points to the Institute of Medicine’s 2009 estimate that 30% of all spending on health care is squandered on inefficiency, fraud, and unnecessary services. He asserts that such wasteful spending could mostly be avoided. Applied across the $2.7 trillion spent on U.S. health care in 2012, that 30% reimbursement change alone would save $810 billion.

He describes today’s reimbursement system as “If I build it, I will get paid for it,” rather than “I get rewarded for making this person better.” Good outcomes should be the goal of both care and reimbursement, rather than simply reimbursing for the mere provision of services.

Second, Sutton’s Law: “Go where the money is.” We need to focus on the big ticket items, the heavy users.  Improve the quality of care for the expensive disorders.  Aetna’s current focus is on diabetes, estimated to cost $130 billion a year in the U.S.  He outlines Aetna’s program to slow the cost of diabetic management.

Third, re-structure the delivery system.  Send the hearts to the Cleveland Clinics and cancers to the Memorial Sloan Ketterings. This operationalizes rewarding those who get patients better rather than simply for developing new facilities and programs that don’t necessarily produce predictably good results.

Bertolini feels that this three-point plan “attacks the entrenched establishment that profits from the existing inefficiencies.” All three points are obviously intertwined.

Meanwhile, one of the biggest ticket items in health care is the cost of care for spinal and musculoskeletal conditions – an estimated U.S. annual cost of $800 billion, including disability costs.  The inefficiencies and unjustified variation in the management of these conditions are documented and substantial.  In my next blog, I will make a strong case for applying Bertolini’s three-point prescription to the management of most musculoskeletal disorders and cite some emerging claims data that not only stop the rapidly rising costs of this care but actually document a 40% savings!

I always welcome feedback and questions. Please be sure to click on “Like” if this was useful and enlightening, or “Leave a Comment” by clicking on “Comment” below. Have a wonderful weekend everyone.


One Response to “A “Fix” for Health Care in the U.S.?”

  1. […] My last post outlined Mark Bertolini’s three-point solution to fixing health care in the U.S. This CEO, President, and Chairman of Aetna advocates promoting evidence-based care starting with “big ticket” health care domains. Aetna currently has diabetes in its cross-hairs for improving cost-effective care. […]

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