Reforms and Innovation Needed to Lower Costs and Improve Quality in Healthcare

By: Tomas Gregorio, Senior Executive Director, Healthcare Delivery Systems iLab, New Jersey Innovation Institute Healthcare in the United States is complicated, inefficient and expensive.  Many individuals and families can no longer afford to see a doctor, fill a prescription or get the most basic medical care without having to sacrifice other essential items such as putting food on the table or paying the mortgage.  These are choices that no American should be forced to make.  Unfortunately, after seemingly endless attempts at reform, the costs of our healthcare system continue to move steadily higher, impervious to all attempts from the government, private companies or other stakeholders to hold back the ever-rising healthcare tide. Healthcare, by its very nature, is resistant to change.  Concerns over privacy and safety often delay the sharing of information or adoption of new technologies that could reduce the costs of care. While these issues are valid, they can and must be addressed as the status quo is no longer acceptable.   This point has not been lost on the U.S. Department of Health and Human Services and the West Health Institute that in a recent whitepaper noted that greater interoperability of healthcare devices alone could help save more than $30 billion a year in wasteful spending.  While the Rand Corporation in an earlier study estimated that full national interoperability could save $77 billion annually. A national network in which all providers have access to medical records is still many years away however, there are steps being taken right now by the Centers for Medicare & Medicaid Services (CMS)  that promise to have a positive impact on healthcare costs and quality.   The initiatives, “Patients Over Paperwork” and “Meaningful Measures” seek to reduce the regulatory and reporting burden on providers. Reducing the amount of time physicians spend on paperwork is goal that I am sure would garner 100 percent support in the healthcare community.  Providers spend countless hours filling out forms or checking boxes that in many cases have no obvious benefit for either the physician or the patient.  Seema Verma, CMS Administrator, noted this problem during remarks on October 30, at a Healthcare Summit when she said, “We publish nearly 11,000 pages of regulations every year. That is a lot of paper, and it’s taking doctors away from what matter most – patients.” Further, the American Hospital Association recently published a report showing that health systems, hospitals and post-acute care providers spend nearly $39 billion a year (let that sink in for a minute) solely on administrative activities. CMS is beginning to address this problem by taking on a full scale review of current regulations by asking some very basic and important questions:  What is the purpose of the regulation? Does this regulation help prevent fraud and abuse? Does the regulation have a meaningful impact on patient care, safety and improving outcomes?   This review alone, and a subsequent role back of regulations has the potential to save untold billions of dollars, improve patient care and restore the sanctity of the provider/patient relationship. CMS’ Measures Management effort is about examining what quality measures should be reported to the government as part of their overall goal of moving our healthcare system from fee-for-service to value-based care. My organization, The New Jersey Innovation Institute (NJII), fully supports this effort and is partnering with CMS through their Transforming Clinical Practices Initiative (TCPI) that seeks to save more than $1 billion in healthcare costs by the end of 2019 by helping physicians adopt value-based care payment models. NJII has recruited a network of nearly 10,000 physicians to be part of the initiative and we are on pace to save more than $135 million in costs and improve the health of more than 500,000 Medicare patients over the life of the program. Meaningful Measures will focus on having providers report only on measures that are most vital to providing high quality care and improving outcomes for patients.   In essence, CMS will focus more on results, less on process, and promote a more market driven health care system. NJII applauds CMS in its efforts to bring innovation to our healthcare system and examine opportunities for advancement.   We encourage healthcare stakeholders at every level to bring their expertise to the table and further the collective effort to lower costs and improve healthcare quality.