Health Affairs Blog commends to readers today’s newly released Institute of Medicine report, “Best Care At Lower Cost: The Path To Continuously Learning Health Care In America.” The report states that “achieving a learning health care system – one in which science and informatics, patient-clinician partnerships, incentives, and culture are aligned to promote and enable continuous and real-time improvement in both the effectiveness and efficiency of care – is both necessary and possible for the nation.” “Best Care At Lower Cost” builds on earlier seminal IOM reports such as “To Err Is Human,” “Crossing The Quality Chasm,” and “Unequal Treatment,” as well the 11 workshop summaries published by the IOM’s Roundtable on Value and Science-Driven Care.
In an interview with Health Affairs Blog, Mark Smith, the CEO of the California HealthCare Foundation and the chair of the panel that wrote the report, summarized the message of the report as “Americans deserve and should expect higher value for your money in health care.” He added: “Fewer resources need not necessarily mean lower quality. We need to get the policies right in order to get the care right, but it is not principally a question of the amount of money.” Indeed, the report calculates that 30 percent of health spending in 2009 – roughly $750 billion – was wasted.
The report discusses improving quality and controlling costs, “but there’s a third problem that we’ve identified as very much linked to both of these issues, and that is complexity,” Smith said. In his preface to the report, he writes: “During the past half-century, there has been an explosion of biomedical and clinical knowledge, with even more dazzling clinical capabilities just over the horizon. However, the systems by which health care providers are trained, deployed, paid, and updated cannot usefully digest this deluge of information.” The new report is “the first attempt that we’re aware of to try to both quantify [complexity] and to address how to attack it in ways that are consistent with our cost and quality challenges as well,” Smith told HA Blog.
Some members of the IOM panel were disappointed with how little progress the United States has made in improving its health care system since “Too Err Is Human,” “Crossing The Quality Chasm,” and “Unequal Treatment,” Smith said. But there was also optimism stemming from the availability of four tools that have emerged in the decade since the earlier reports were issued:
1) Computing power. “If you think about how ubiquitous and how powerful and how cheap computing power is now, it makes possible all sorts of things that simply weren’t available before,” said Smith.
2) Connectivity. “It’s one thing for you to have computing power on an island that is isolated and self-contained, but the capacity for everybody to talk to everybody else in more or less real time again presents dramatic possibilities that weren’t available to us until relatively recently.”
3) Organizational sophistication. Smith said he had just returned from visits to Denver Health and ThedaCare in Appleton, Wisconsin. “Seeing what these organizations have done in the last decade with “Lean,” seeing what Eugene Litvak’s organization [the Institute for Healthcare Optimization] has done with smoothing patient flow, this is dramatically more sophisticated … than we had ten years ago. “
4) Advances in teamwork. Smith said the notion of teamwork included not just all types of clinicians “but also patients as part of the team. If you think about how active and engaged, even confrontational, patients can be now, how well informed and eager to be even better informed they are, and how accessible information is to them, it’s light-years ahead” of ten years ago.
“Best Care At Lower Cost” was sponsored by the Blue Shield of California Foundation, the Charina Endowment Fund, and the Robert Wood Johnson Foundation.