Wednesday, March 18, 2009

An Idea for Health Care Reform: Target It at Making America Number 1

When an expert contacts the Disease Management Care Blog, it pays attention. That's especially if that person is Robert Stone, co-founder of Healthways and a past President of the DMAA. Bob is no stranger to the ways of Washington DC and has more than his fair share of health policy mojo. Bob pointed out that he had shared his perspectives on health reform during Day 2 of the recent Disease Management Colloquium titled Changing Times, Changing Solutions. He made a transcript of his comments available to the DMCB and they make for interesting reading.

As the DMCB interprets it, Bob warns that we are headed down the same path of wrongly talking about the wrong things when it comes to health care reform. Various fixes, while creating meaningful and measurable micro improvements, have not been sufficiently robust to create the macro changes at which they were aimed. While everyone agrees – again – that reform is urgently needed, vague nostrums like “equitable,” “accessible,” “affordable,” “quality” and “transparent” abound. Each stakeholder imbues those words differently from every other stakeholder while working hard to keep their share of the health care economic pie. The result has been a sorry record of tinkering around the edges based solely on a combination of self-preservation, the prevailing political winds and whatever ideology in vogue at the time. Given the lack of any coherence, opponents to some or any elements of reform can derail the entire process.

So what should we do? While Newt Gingrich loves to quote Eisenhower, Bob does also, but he uses a better one: "We succeed only as we identify in life, or in war, or in anything else, a single, overriding objective, and make all other considerations bend to that one objective." Like any seasoned healthcare executive, he knows that if you don't measure it, it doesn't happen. He also knows that most successful businesses have to choose a limited set of measures and manage to them. Using that compelling logic, he proposes that at some agreed to point in the future, with milestones along the way, that the objective be to make America rank #1 in the world in an overarching, comprehensive and easily understood measure of health status. If adopted, three things would likely result: 1) we’d meaningfully divert resources toward keeping healthy people healthy, 2) we’d see funding dedicated to helping people mitigate or eliminate the health risks associated with unhealthy lifestyle behavior choices and 3) the provision of evidence-based care to those who are ill would increase.

The DMCB finds the concept intriguing. It's outcomes based. Once we know what we are 'managing to,' what should and what should not be included in healthcare reform would become clearer. Overall health status measures are well within reach (examples are here - despite problems with how the WHO measures are collected and how they're interpreted - and here) and can be assembled either as a single score or in a 'dashboard.' Once established, Congress would be paying attention to conditions like this instead of worrying about nonsense like this.

Which brings the DMCB back to Newt. The other Eisenhower quote is "If a problem cannot be solved, enlarge it." Forcing healthcare reform to land on an overarching measure and manage to it certainly makes it visible, focuses it like a burning platform, would seem to promote bipartisanship and will make our elected representatives far more accountable than they are now.

Want a copy of Bob Stone's address? You can email him here.

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