Does Prevention Make A Difference?
However, plenty of experiments, including those conducted by the feds in Wenatchee WA as precursors of the medical home modes, have shown that the total net spending goes down and quality goes up simultaneously. I am particularly familiar with this experiment because participants are active members of the Quality Council of the American Medical Group Association, of which I am the current chair. We have had presentations from this group -- formally and informally -- at AMGA's annual conference and at the Institute for Quality Leadership (the other yearly meeting of the group).
I would add that prevention is too narrow of a term for the changes that come about from the medical home model (itself a new iteration of old established public health concepts). There are large savings which are realized in a shorter time period than those resulting strictly from prevention.
The trick, of course, will be to make the payment system align with this re-orientation of what we call primary care. Again, many of the experiments conducted by the government, as well as experiments carried out privately inside of the large medical groups, show that this is achievable.
reason why we have unacceptably high healthcare costs (of that day) is because we have an inadequate supply of hospital facilities and physicians.
premium costs on a sustained basis because of breakthrough practices, we would or should know more about it.
Indeed much of the very theory of HMOs was prevention and paying providers to provide health.
If anything, I am sort of surprised how quickly we are simply repackaging the same stuff. I used to think if we cut hospital utilization in half, dealt with providers known to be less costly, intervened on large cases, and negotiated preferred rates in exchange for more focused patients, we would get to sustainable strategy, but we didn't.
The question is not whether prevention is good or bad policy, but whether it can be relied upon as a key leverage point to reduce healthcare costs. I don't think it can, but what do I know other than the nature of how the ebb and flow of money works in this business.
Stephen Gregg is a retired hospital administrator and health plan chief of staff. He can be reached at [email protected].