I recently watched a video editorial by Dr. Karen Davis over at Medscape General Medicine (registration required to view). It discussed the findings of The Commonwealth Fund’s Commission on High Performance Health System on the characteristics of high-performance health systems. According to the editorial, all Americans should have the opportunity for:

  1. Long, healthy and productive lives
  2. Appropriate care for their health needs
  3. Coordinated care over time that reduces duplication of tests, treatments and procedures
  4. Safe care that “does no harm”
  5. Patient-centered care that reflects patient preferences and values
  6. Efficient, high-value care
  7. Universal access to care
  8. Affordable care that does not undermine financial security of the patient
  9. Equitable care that is not influenced by income, race, or ethnicity
  10. Care that is innovative and focused on improvement.

The full report can be found here.

I agree with Ms. Davis that these are quite lofty goals given the complexity of the US healthcare system. The full report does provide some suggestions on how to make progress toward achieving these goals. Many of these “levers” are focused on making new policies to correct the market failure in our system.

One of the first suggestions in the report is to “restructure financial incentives” including changing provider reimbursement to promote high quality and efficient care. As we have seen, doctors are not really fond of the implications of this solution. Additionally, the report makes a place for increased patient cost-sharing. Here again, patients don’t like this either. It also calls for businesses to become more involved in demanding health plans that find innovative ways of focusing on efficient and quality care.

Importantly, the report also advocates for information and transparency in the system.

Information about quality, safety and efficiency of care can be used by health plans, providers, consumers, and patients to determine the most effective use of limited resources

The report has a lot to say about the state and federal government’s role in helping to define quality and best (evidence-based) practices. Additionally, the report calls for the government to be very involved in the funding and standards around the implementation of HIT.

Hmmmmm……..More accountability for providers, more investment from patients, more demands on health plans by businesses, more investment from companies for oversight to insure the quality and efficiency goals are being met, more involvement of the government, more cost to the taxpayer. Wow! It sounds like everyone is going to be unhappy.

After reading this report, I’m still convinced that things are lining up so that patients are going to be required to take a more active role in coordinating their care. Having good systems for educating patients on their treatment, treatment options and expected outcomes will be crucial. Additionally, the patient-provider relationship is on the cusp of big change. To date, that relationship has been a bit unbalanced — with the provider having more prestige and power than the patient. In the future, the relationship will have to become more of a partnership that considers patient values and preferences as well as quality of the outcomes and efficiency, rather than simply dictating treatment without discussion of the options.

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