From Everyone agrees that we need cheaper, better, easier care for everyone. You know it. The guy heading to the White House knows it. Congress knows it. But knowing and doing aren't necessarily neighbors in Washington, D.C. In any case, we don't have to wait for the wonks to fix health care. Our team interviewed dozens of experts from think tanks, business, academia, nonprofits, government, hospitals, and private practice -- some of the brightest minds dedicated to making America (and its health care system) healthier. They shared their best examples of what has worked and what may work to save some of the $2 trillion we spend every year. Save big enough and we could cover the millions of people who go without coverage. Here's how to make it happen.
1. Fight the Big Five
Common chronic conditions (including coronary artery disease, diabetes, congestive heart failure, asthma, and depression) are responsible for 75 percent of our health care spending. George Halvorson, chairman and CEO of Kaiser Foundation Health Plan and author of Health Care Reform Now! A Prescription for Change, argues that we should follow the money -- and fight these diseases with all we've got, including early intervention and consistent follow-up care.
The payoff: If just 1 percent of people with these conditions were successfully treated, we could shave at least $77 billion off the health care tab. "Diabetes is the fastest-growing disease in America," he says, so focusing on that alone could save billions. "Medicare can be saved if we could cut the number of people becoming diabetic in half."
The action plan: Type 2 diabetes, in particular, is a lifestyle disease. Just a simple 30-minute walk every day, says Halvorson, could help achieve his 50 percent goal. We can all take more responsibility for our own health. Start a walking club. If you have diabetes or heart disease, follow up with your doctor and commit to a treatment plan. Learn more at fightchronicdisease.org. Need more motivation? Check out deathclock.com, suggests Rep. Jim Cooper (D-TN). It lets you see your statistical expiration date, given the risk factors of age, weight, and smoking.
2. Reduce Medical Errors by Thinking Like an Airline
Medical mistakes kill nearly 100,000 people every year, according to the Institute of Medicine. "That is equivalent to a 747 crashing every other day," says Denis Cortese, MD, president and CEO of the Mayo Clinic. These errors, more than half of them preventable, cost the United States as much as $29 billion each year.
Dr. Cortese thinks the health care system can learn from its mistakes the way the airline industry does. If a 747 crashed here, he says, the FAA would swoop in and analyze the accident, check airplanes nationwide, and do everything possible to prevent another accident. "All employees of the airline industry are expected to report near misses and mistakes within 24 hours," he says. "There is an investigation, people are thanked for making the report, and efforts are made to try to improve the services. In our health care system, when mistakes occur, we try to keep it as quiet as possible." Dr. Cortese suggests a federal health care safety reporting agency using a systems engineering approach so that medical errors can be logged, studied, and addressed -- without fear of punishment.
The payoff: A program like this could save lives and at least $17 billion a year.
The action plan: Find out more about the Mayo Clinic's health care reform efforts at mayoclinic.org/healthpolicycenter. For other efforts, visit the nonprofit National Patient Safety Foundation at npsf.org.
3. Get It Right the First Time
What a waste: As much as $312 billion is frittered away each year when patients are misdiagnosed or given the wrong treatment. Best Doctors, a health benefit offered through hundreds of insurers, health plans, and companies, is one way to help.
Founded by physicians affiliated with Harvard University School of Medicine, the Boston-based company offers its members in 30 countries customized second opinions from its network of top specialists and subspecialists around the world. For example, scans of a 12-year-old girl in Maine showed tumors in her liver and one lung, an apparent relapse from the rare form of cancer she battled as a toddler, her doctors said. But when the biopsy came back negative for malignant cancer, no one knew what to do.
The girl's father decided to try Best Doctors, a benefit offered and paid for by his employer. After top experts reviewed the girl's scans and records, they concluded the masses in her liver were a side effect from a drug she had taken years ago, while a spot on the lung was damaged tissue from her previous surgeries. The treatment? Leave the harmless masses alone. The review helped the girl avoid further biopsies and costly invasive surgeries.
The payoff: EMC Corporation, a large technology firm in Hopkinton, Massachusetts, consulted Best Doctors on 60 cases in its first year using the program. Diagnoses were changed in 15 percent of those and treatments were modified in 85 percent, resulting in $500,000 in savings.
"If everyone got the right diagnosis and treatment the first time," says Evan Falchuk, president of Best Doctors, "we could save tens of billions of dollars and an untold amount of unnecessary suffering and give millions of people the best chance to get well."
The action plan: For more information, go to bestdoctors.com or ask your employer's benefits department about a second-opinion program.
4. Pay Employees for Healthy Habits
When Safeway CEO Steve Burd discovered that 70 percent of health care costs are linked to unhealthy habits, he created incentives that sent his employees scrambling for the produce aisle. "No one quarrels with the fact that if you have three speeding tickets a year, you're a higher risk and should pay more for auto insurance," says the 58-year-old fitness buff. "Our new plan encourages employees to live healthier, and if they don't, then they bear some of the costs." Perks include lower premiums for those who lose weight or quit smoking, free or cheap gym memberships, and a $1,000 health care reimbursement check to encourage cheaper choices like generics over name-brand drugs.
The payoff: The company's new plan has saved 13 percent so far, and employees who've signed up have saved 20 to 30 percent on their premiums. If other companies followed Safeway's lead, the country could save $600 billion to $800 billion.
The action plan: Watch a video of Steve Burd at safeway.com (click on About Us), and learn more about his reform plan at coalition4healthcare.org.
5. E-Prescribe
Paper prescriptions are archaic and lead to 1.5 million injuries and 7,000 deaths each year from errors. But if every doctor got on board with an electronic Rx system, it would improve safety by making prescriptions easier to read and providing instant checks on drug interactions, dosages, and a patient's medication history. Doctors have been slow to make the expensive switchover, but now they can get free e-prescribing software through an initiative (nationalerx.com) launched by software company Allscripts. Also, physicians can now securely trade patient health and medication history through SureScripts-RxHub, the first nationwide network for e-prescriptions. Congress is providing incentives to increase Medicare payments to doctors who e-prescribe.
The payoff: This could cut drug-related injuries by a third and save $4 billion annually.
The action plan: Find out about studies, conferences, and events at ehealthinitiative.org, run by two nonprofits.
6. Use Retail Clinics for Routine Care
"Minute" clinics in major drugstore chains can help simplify health care, says Harvard business professor Clayton Christensen, by "offloading some of the work to nurse practitioners, physician assistants, and even patients." The AMA isn't keen on the idea: It wants doctors to at least supervise these clinics. Still, they're safe for minor things like sore throats, pulled muscles, pinkeye, wart removal, and vaccines.
The payoff: They're faster and more convenient. Plus, if you're uninsured, you'll pay 30 to 80 percent less than what you'd shell out for a doctor (and much less than you'd pay by going to the ER). For those who do have coverage, major insurance is usually accepted.
The action plan: Visit the Convenient Care Association at ccaclinics.org to find a clinic in your area.
7. Share Information to Fight Cancer
Could it really be this simple? Get the FDA and the pharmaceutical industry to talk more openly so patients can get safer drugs more quickly and inexpensively. The nonprofit Critical Path Institute (C-Path) believes we can save money and lives by speeding up our nation's sluggish and costly drug-approval process.
One project under way: C-Path brought 18 drug, biotech, and diagnostic companies together (many of them fierce competitors) to collaborate on a major lung cancer trial. The 18 companies are hoping to develop mutually agreed-upon tests that would allow the FDA to get results in as little as a week rather than years, says Raymond Woosley, MD, president of C-Path.
The payoff: Speeding up the trial process could reduce the number of costly failed drugs and lower the price of prescription drugs in general.
The action plan: Visit c-path.org for more information.
8. Measure Results and Make Them Public
When doctors and patients work together to meet tangible health goals that yield proven results, great things can happen. That's the idea behind nonprofit Minnesota Community Measurement. The group sets standards of care for 14 conditions, and the onus is on doctors to counsel, motivate, and even push their patients to get with the program. The organization gathers outcome data and posts the percentage of patients at each clinic who meet all the standards for a particular condition on mnhealthcare.org.
The payoff: While it's not easy to get people to change their lifestyles, compliance in diabetes patients has risen from 4 percent in 2004 to 11 percent in 2007. Jim Chase, executive director, estimates that if these improvements were adopted nationally, we could save more than $1.6 billion a year.
The action plan: If you have a chronic condition, work with your doctor to set goals in writing.
9. Stop Unnecessary Treatments
We spend more than any other country on health care, but we're not healthier for it, partly because so much of the care delivered here is unnecessary, says Shannon Brownlee, author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.
"The way to fight waste," she says, "is by reorganizing the way doctors and nurses and hospitals provide care. There are models out there of high-quality, low-cost care, and they include some of the most trusted names in medicine: the Mayo Clinic, Kaiser, and Intermountain Healthcare. These programs have a primary provider coordinate all the care. They understand that 21st-century medicine is a team sport. They also put a premium on analyzing the best available evidence and then ensuring that their doctors follow it."
The payoff: "Cutting out even half of the unnecessary health care in this country," Brownlee says, "would be enough to cover every citizen who is now uninsured."
The action plan: Go to overtreated.com to learn which questions to ask your doctor; you'll find resources and links for further information.
10. Reduce Infant Mortality
More than 2,000 infants die in the United States every month, many because they're premature. "The rate of premature births has been increasing steadily for decades," explains Joann Petrini, PhD, director of the perinatal data center for the March of Dimes. More smokers, more moms over 35, and more multiple births (due in part to more women having fertility treatments) are just some of the reasons. "You could do everything right and still end up having a preterm baby," says Petrini. "We need more research into how and why it happens."
The payoff: Preterm births cost us more than $26 billion a year, so preventing them would save billions of dollars and thousands of lives.
The action plan: Support the campaign at marchofdimes.com.
11. Make Schools Healthier
- Reward healthy eating. The nine million obese kids in this country are set to become the first generation with a shorter life expectancy than that of their parents. Schools can help by encouraging fun physical activity and rewarding healthy eating. One school's success story: When Yvonne Sanders-Butler became principal of Browns Mill Elementary School in Lithonia, Georgia, a decade ago, 20 percent of her students were overweight, and just over half were passing state academic tests. She soon discovered that a typical breakfast for many students was a doughnut, candy, soda -- or nothing at all. She also found 300 slips on file excusing students from gym. "These kids were couch potatoes," says Sanders-Butler. She approached her PTA with a drastic plan: Ban candy, soda, and sugary snacks from brown bags and cafeteria lunches. Homeroom teachers now inspect all lunches and snacks and replace contraband treats with a banana or an apple. Kids and parents sign a wellness pledge, and students who stick to the program (called Healthy Kids, Smart Kids) win homework passes and other prizes. Now Sanders-Butler is working with the Robert Wood Johnson Foundation to help spread the word (healthykidshealthycommunities.org).
The payoff: Today you won't see a single obese child walking the halls, and 80 percent of students pass the state tests. As of September, 17 other schools had joined the program.The action plan: Make the sugar-free case to the principal and PTA at your child's school. For more information, go to healthykidssmartkids.com.
- Rescue recess. In many schools, where recess hasn’t been pushed aside for academics, many students use those precious minutes to hang out rather than burn off the cheeseburgers. But at William H. Ohrenberger Elementary School in Boston, nearly 90 percent of all students participate in recess games. Fewer than half of all kids did two years ago, before the group Sports4Kids started visiting the school, says principal Stephen Zrike.
"We feel play is the single most effective way to promote physical activity," says the group’s founder, Jill Vialet. "It's not someone wagging a finger at them, telling them they need to lose weight." Through fat-busting sports like kickball and dodgeball, trained recess coordinators teach kids the fundamentals of play, including the rock-paper-scissors method of resolving conflicts.
The payoff: Making daily physical activity fun can set good habits for life.
The action plan: Visit sports4kids.org, or search for the group’s videos on YouTube.com. - Expand gym class. The award-winning PE curriculum in the Hortonville, Wisconsin, school district includes non-jock activities, including golf, archery, dance, and fly-fishing. The goal is to help students find something they love so they’ll continue to do it well into adulthood. Students regularly use pedometers and heart monitors, both during gym and in the state-of-the-art cardio rooms.
The payoff: This past year, 70 to 80 percent of middle and high school students were within fitness targets based on heart rate and number of laps completed in an endurance test. A decade ago the rate was less than 40 percent.
The action plan: The National Association for Sport & Physical Education rewards schools across the country that have outstanding phys ed programs. See what makes the grade at aahperd.org/naspe/stars.
I have worked in med. for yrs. Socialized healthcare is NOT the answer. LIMIT SELFREFERRALS...when a provider orders a test/procedure that s/he does himself. Especially bad in medical imaging, the largest h/care cost. It is well known that MDs who own MRI/CT equip. increase referrals by 70%! Maryland doesn't allow it. It should be banned federally! Docs are looking for ways to make more $ and to cover malprctc insurnc. Capping rewards & limiting selfreferrals would fix a lot of the mess.
And why does RD.com limit the postings? Are you afraid that by allowing people to submit one, albeit not a thesis, that they just might post something that contradicts RD's opinion? What ever happened to free speech in America? BTW, it died when the internet came into being. You do NOT want to hear the real, correct answers on here
What you fail to realize is that the fault lies with the health care providers (Blue Cross/Blue shield for one) AND the hospitals who provide the care. Both charge for services that are way beyond reasonable. When you force them to reduce their fees, then you will have solved a major problem in the health care industry. There was an instance in MD where a Blue Cross Manager retired and they were going to pay him 21M . It went to the MD courts and they reduced the award to 9M, what a deal!
Drug companies should not be allowed to advertise. The advertising budgets are as large or larger than research. New drugs should be in medical journals, but not on TV or in magazines. The money should be used to reduce drug costs, especially for senior citizens. Charlee Helms, Midland TX
The problem with "mandatory temp life insurance" to eliminate malpractice is that it doesn't address the problem of "eliminating" the doctor/healthcare provider who is doing the malpractice - seldom a 1 of thing. And making it illegal for companies to advertise their products might mean people don't learn about something that could help them - heaven knows the MDs can't keep up with everything.
1. Impartial monitoring of both physicians and nurses - to eliminate the ones whose clinical and personal problems cause the highest damages/losses. 2. Require hospitals to give accurate references on RNs with clinical/personal problems, instead of wimping out to avoid legal problems. 3. Eliminate the overseers of state medicaid programs, who by requiring lower level testing, rather than that MD ordered, wind up costing us twice as much, rather than saving money - requiring 2 tests instead of 1.
You didn't list my favorite cost-cutting measure (that came out during the failed Clinton healthcare reform efforts of 1993/4): If insurance companies would just standardize their 1,500 different claim forms, that alone would save $50-75 billion. ALL the forms ask for the exact same information...so what's so hard about it? And yet, THAT - probably the easiest to accomplish -- couldn't get done.
FDA Reforms 1. only award patents for drugs that are safer, cheaper, and/or more effective then current drugs (current policies is they only have to do better than a placebo) 2. Prohibit executives from joining pharmaceutical industry (as the last 3 directors did) 3. Enable companies to bypass FDA laws with unlimited liability (subsidiary if needed), no unsolicited advertising, and no use of federal funds (including VA) ; after x # yrs, they can apply for patent after market testing
Complaint: While IT may enhance quality, there is no consensus IT will reduce costs. Proposal: 1. eliminate employer sponsored healthcare through the tax code so consumers can choose what they want 2. Consolidate State medicare/medicaid grants to block grants (currently fed gives restrictions on which medical services are provided) 3. Someone else suggested having mandatory temp life insurance before all surgeries to eliminate malpractice insurance
I was good with everything up to number 18 (everyone pays the same no matter what) which directly contradicts the two businees plans that charge those who have behaviors that will result in higher medical cost pay more than those who live healthy.
Why in the world is NO ONE looking at the cost of ADVERTISING the pharmaceuticals and durable medical equipment (DME) such as defibrillators and pacemakers, etc, as one of the biggest inflators of health care costs?? Billions per month?? And we haven't even touched on it? Make it illegal for the "drug companies" to advertise directly to the public, to whom they cannot prescribe their products! That's my solution!! Write your Congressman or woman!