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Transforming Healthcare: Part I
By Larry Warner / May 27, 2016 /   Loading Disqus...
Healthcare reform and transformation is a topic that affects people from all walks of life. For my first of a series of blog posts about the Rhode Island Foundation’s work in the Health sector, I will be exploring the questions below, and the Foundation’s role in transforming healthcare:
1. Why do we need to reform (or transform) healthcare?
2. How do we reform/transform healthcare?

I’ll also talk more about the Foundation’s focus on ensuring that all Rhode Islanders have access to quality primary care.

"Healthcare reform means the right care for less money, not less care."

               –  Local Mental Health Administrator

These are undoubtedly complex questions. Many hours have been spent by researchers, economists, consultants, policymakers, providers and patients arriving at answers and debating which solutions are the best. The discussion about healthcare reform and transforming the healthcare system is much like looking at the routes suggested by Google Maps to get from Providence to San Francisco – some routes are faster, some are longer and have more turns in them, but no route is going to please everyone. As Rhode Island’s community foundation, we are active in the discussion of how the state navigates this journey towards a transformed healthcare system.

Why do we need to reform and/or transform healthcare?

These three words: Cost, Quality, Access.

Cost: As a country, we spend a LOT of money on healthcare. The United States spends roughly $8,700 per person and 17.1% of its gross domestic product (GDP) per year on healthcare, and we don’t have the health outcomes to show for it. By comparison, our healthcare spending is one and one half times that of France (at 11.6% GDP), our closest spending comparator. People without primary care or health insurance often defer care or use hospital emergency rooms in times of crisis, driving up costs of healthcare for everyone.

Because healthcare spending cannot be allowed to increase uncontrollably, the Rhode Island Foundation is actively engaged in planning around and investing in innovative payment and delivery models, one of our health sector priorities. With value rather than volume as a goal of the healthcare system, we are working with government, academic institutions, hospitals, physician practices, and community based nonprofits to provide the right care for less money in order to achieve healthy outcomes.

Quality: For the significantly greater spending on healthcare, you would expect safer care, better coordination, patient centered care, better health, longer life expectancy, and lower infant mortality. Surprisingly, the U.S. is around the middle of the pack compared to its peers on quality measures, and ranks last in the efficiency of its healthcare system.

We are achieving better health outcomes compared to 20 years ago, however we still have higher death rates from heart disease, diabetes, and have a higher infant mortality rate than other economically developed countries that spend less on healthcare. This is without considering variation in healthcare spending and health outcomes between states (let alone ZIP codes), or disparities in outcomes between racial and ethnic groups.

We are far from the finish line, but Rhode Island made the most strides in promoting equity in healthcare according to a recent Commonwealth Fund report. This is a result of the collective effort of policy makers, healthcare providers (individuals and organizations), funders and other community partners investing brainpower, political will, and financial resources into working towards health equity.

The Rhode Island Foundation has contributed to this statewide effort to achieve health equity by investing in a loan forgiveness program for primary care providers (physicians, nurse practitioners, physician assistants) working in high need areas (i.e. patient panel consists of >25% Medicaid patients). In conjunction with other incentive programs, the Rhode Island Foundation strives to increase the number of healthcare providers practicing in primary care settings, and improving access to primary care.

Access: Access is determined in part by the presence of and proximity of consumers to healthcare providers. In order for consumers to access primary care, they must also be aware of the existence and importance of primary and preventive care resources, and in turn use them. For this reason, promoting the use of primary care medical homes is one of the Foundation’s priorities in the health sector.

How do we reform/transform healthcare?

From Merriam-Webster Dictionary:

reform (verb) – a: to put or change into an improved form or condition b: to amend or improve by change of form or removal of faults or abuses

transform (verb) – a: to change in composition or structure b: to change the outward form or appearance of c: to change in character or condition

Love it or hate it, the Affordable Care Act (ACA) of 2010 passed by Congress and signed by President Obama was the single biggest step for our country towards decreasing spending and improving outcomes. Why? Because it started our nation on the journey towards our destination: an improved healthcare system with different structures (i.e. accountable care organizations), a change in the outward appearance (i.e. patient centered medical homes), and a change in character (i.e. not ranked poorly in quality and outcomes).

Remember the Google Map example? Could we have taken another route? Sure. Was it the fastest route or the shortest route? That remains to be determined. What we could not do is continue to kick the can down the road on spending and health outcomes by continuing to conduct business as usual. Google will update the time and distance remaining on your trip once you are underway. But nothing changes until you start the journey.

One of the many things that the ACA attempts to accomplish is moving healthcare delivery and reimbursement towards value-based rather than volume based systems. Locally, the Rhode Island Foundation is playing a leading role in discussions about moving away from a model where reimbursement occurs solely on a fee-for-service basis to a model that rewards quality and performance. Many Rhode Islanders currently face barriers to quality healthcare, and we believe that we will help improve health outcomes, reduce costs, and increase the quality of care by improving access to primary care for every Rhode Islander. We are fortunate to partner with health, community, and government leaders who are committed to shifting the focus towards keeping individuals healthy and caring for patients efficiently and effectively.

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