By Diane Carman
Listening to the candidates vying for the Republican presidential nomination might lead your average health care consumer to think the system is on the verge of collapse.
While the Affordable Care Act is not yet fully implemented and remains in large part unproven, some health care systems around the country are demonstrating the potential for significant improvements in cost control, access to care and better outcomes. They also are acting as testing grounds for such health care reform concepts as medical homes, virtual health care, electronic medical records, integrated behavioral health care and revenue pooling across care organizations.
U.S. Health Care: The Good News, a documentary produced with support from Rocky Mountain PBS and grants from several local foundations, tells the story of health care systems in Grand Junction, Seattle and Everett, Wash., that all have found ways to expand coverage, improve care and cut costs.
The film, produced by Colorado filmmaker Lisa Hartman and featuring Colorado journalist and authorT.R. Reid, will be broadcast on RMPBS at 9 p.m. Thursday. It also will air nationally on PBS.
Among the local health care professionals featured in the film is Steve ErkenBrack, who is president and CEO of Rocky Mountain Health Plans.
Heres the scoop, said ErkenBrack in one segment of the film, healthy people cost less than sick people.
The emphasis in the Rocky Mountain Health Plans program, he said, is to use the medical home model, which is designed to provide comprehensive care to patients to manage chronic conditions and avoid acute problems that result in expensive emergency room visits or hospitalizations.
The organization also exploits electronic medical records to manage patients more efficiently and reduce unnecessary diagnostic procedures, and it pools revenues to pay providers salaries instead of compensating them by the number of procedures they perform.
The filmmakers credit the Grand Junction model with saving lives and saving money.
Group Health in Seattle, a co-op model, and the Everett Clinic both also have made dramatic progress toward universal health care at lower cost, according to the film, which uses data assembled in the Dartmouth Atlas of Health Care.
Group Health and the Everett Clinic focus intensely on prevention and management of costly chronic conditions such as diabetes, heart disease and obesity, and have produced significant cost savings for their subscribers. Boeing, for example, reportedly cut health care costs for its employees by 20 percent by enrolling in the programs.
In his narration of the film, Reid said that care costs in Grand Junction were one-third those of health care organizations in Miami, Fla. Overall, he said, the United States could cut its health care spending by 30 percent if the country moved toward the practices in place in these organizations, which represent some of the lowest-spending regions of the country.
Thirty percent of health care spending is devoted to unnecessary care, he said.
During a panel discussion following a preview of the film last week, Patricia Gabow, CEO of Denver Health, pointed out that health care in the U.S. is a $2.7 trillion industry. If it was a country, it would be the fifth-largest economy in the world.
One reason for the lack of progress in cutting costs, she said, is that if we get rid of waste, its money out of somebodys pocket.
Reid emphasized that there is a fundamental conflict in a system where shareholders expect to get the highest dividends possible on their investments while taxpayers and consumers want care provided at low cost.
Still, all of these things are doable, said Marguerite Salazar, director of Region VIII of the U.S. Department of Health and Human Services. Were watching whats going on around the country. Grand Junction is on our radar as a pioneering health care organization.
The health care organizations profiled in the film have identified a wide range of practices that can improve care and reduce costs in every community, and even without mandates for change, the federal government can provide incentives and disincentives, she said.
The Good News hardly breaks new ground in profiling the Grand Junction model as an example for controlling costs, increasing access and improving health outcomes, but the film illustrates the concepts and practices employed there in a clear and understandable way.
No advance degrees are required to see why these programs are effective, and Reids avuncular style contributes to the success of the filmmakers persuasive case for the need for dramatic systemic change in health care.
Diane Carman is editor of Solutions.