Aug 1, 2014, 4:29 PM, Posted by
Want to know one of health care’s dirty little secrets? While we know how much the country spends on care each year, we have little understanding of what it actually costs to provide care.
Think, for example, about an appendectomy. What does it really “cost” the health care system to perform that procedure? The answer is complex, and of course it includes everyone’s time—from the surgeon to housekeeping staff—and it also includes the drugs, equipment, space, and overhead associated with your stay.
The cost of your visit will also depend on who is delivering your care. A consult with a registered nurse (RN) is less costly to the hospital than one with a physician.
Then, consider insurance. If the price your carrier pays for that RN consult is $85, but the price another carrier pays is only $65, what does it actually cost the hospital—and how do those variances affect what you pay both out-of-pocket and for insurance premiums? Moreover, health care providers are currently not trained to think about the costs of the care they provide—and often have no incentive or means to even consider those costs.
These complexities have made it difficult to reform the way we purchase and pay for health care.
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Dec 11, 2013, 8:00 AM, Posted by
Pioneer Blog Team
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Welcome to episode two of our podcast. This time we kick things off with our new Mailbag segment, in which Senior Program Officer Paul Tarini answers questions from listeners (time stamp: 1:12). Next, in a conversation with Assistant Vice President of Research and Evaluation and former Pioneer Team Director Brian Quinn, social scientist, innovator, teacher and recent What’s Next Health guest BJ Fogg talks about the need to help people understand how behavior works so they can be more effective in changing their own behavior (4:34). Then we listen in on RWJF’s first-ever Pitch Day, emceed by the Foundation’s Entrepreneur-in-Residence, Thomas Goetz, and featuring judges like angel investor Esther Dyson and NPR science correspondent Shankar Vedantam (8:10). Finally, Senior Program Officer and physician Mike Painter shares a personal story and a plea for getting the human motivators right in health care (16:11). This episode is hosted by program associate (and former TV broadcaster) Christine Nieves.
We hope you enjoy listening, and we hope you learn something; we certainly did. And there’s more to learn: Share your thoughts and ideas in the comments section below, as well as any questions that you’d like us to answer in a future episode.
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Dec 10, 2013, 1:34 PM, Posted by
The conversation is nearly everywhere I go for work lately. More than cost trends, or accountable care organizations, I hear people in both public health and health care circles talking about how we need to be better connected.
Across a variety of health roles, many people are embracing the belief that individuals and the communities we live in will be better off—regarding health outcomes, health care cost, health disparities, corporate productivity, individual quality of life, and so forth—if health care providers, the public health system, and social services are better connected to each other and to the communities in which patients live.
Fortunately, it’s not all talk. In communities across the nation people are trying their best to connect systems to improve the overall health of those who live there, driven by a combination of compassion, pragmatism, pressure, policies, and overall gestalt.
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Sep 6, 2013, 4:30 PM, Posted by
“Pay no attention to the man behind the curtain! The Great and Powerful Oz has spoken!”
In some ways, our health care system has traditionally functioned much like the fantastic land of Oz depicted in one of my favorite movies. Consumers and purchasers are expected to be passive consumers, doing what they are told and paying whatever price is levied based on a high degree of trust and limited information. This model seems increasingly ridiculous. We now face an urgent need to improve the quality and efficiency of our health care system.
But to do that, we need information, a lot of information. Health professionals, purchasers, consumers—basically anyone who comes in contact with health care—need timely, accurate, comprehensive information on cost and quality if they are to make smart decisions. Without such information, not even a wizard could do the trick. But right now, such information is usually unavailable, or, when it is accessible, too often indecipherable. In fact, the Institute of Medicine estimates that $105 billion is wasted every year in the U.S. because of a lack of competition and excessive price variations in health care, and a lack of information on the price of health care services plays a large role in this waste.
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Aug 14, 2013, 2:14 PM, Posted by
An old joke has it that the doctor’s pen is the costliest technology in medicine, since money typically flows where physicians’ prescriptions and other orders decide that it should go. As a result, influencing these decisions is key to achieving the Triple Aim of better health and health care at lower cost.
But what’s more likely to influence doctors: external factors, such as bonuses for improving the quality of care, or internal factors, such as appealing to their sense of altruism or satisfaction with their work? In other words, carrots, sticks, or something altogether different—what Daniel H. Pink, author of Drive, calls “our innate human need to direct our own lives, to learn and create new things, and to do better by ourselves and our world”?
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Mar 22, 2013, 9:00 AM, Posted by
Brendan Saloner, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar in residence at the University of Pennsylvania and a senior fellow at the Leonard Davis Institute of Health Economics. This is the first in a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the recent AcademyHealth National Health Policy Conference reflect on the experience.
Like Goldilocks wandering through the house of the Three Bears, policy-makers in search of a health care payment model have found it difficult to settle on an option that is "just right."
Fee-for-service—paying doctors separately for each service they provide—leads to too much unnecessary and duplicative care (too hot!). Capitation—paying doctors a fixed fee for caring for patients—leads doctors to skimp on care and avoid costly populations (too cold!). A "just right" payment model should give providers incentives to provide all the clinically necessary care to patients while keeping costs low.
Shared savings models—allowing providers to keep a portion of the money they save caring for patients—have been touted as one method for aligning the incentives of providers and payers. Most prominently, shared savings is a central element of the Affordable Care Act's Accountable Care Organizations (ACOs).
An ACO is a network of providers that have agreed to accept a bundled payment for treating patient populations, and in return stand to gain incentive payments for meeting performance targets (or to lose money for missing targets). In the "happily ever after" version of ACOs, groups of providers will finally have a business case for coordinating patient medical records, reducing costly visits to the emergency room, and improving patient compliance with chronic disease therapies without leading to excessive procedures or gaps in care. Healthy patients, healthy profits.
But will it work?
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