Financing health care, not sick care, the BSWQA way

This is the third and final post in a series about Baylor Scott & White Quality Alliance, a clinically integrated accountable care organization. Read part 1 and part 2.

It’s ironic: we regularly refer to the American “health care” system, when what our country really has is a “sick care” system. That’s because for the past 50 years, we’ve focused almost exclusively on treating disease and performing procedures to address health problems after they present.

A true “health care” system would mean being much more proactive on maintaining health and intervening in the earliest stages of a medical challenge. Unfortunately, there is very little financial reward for focusing on this concept in our current system of fee-for-service medicine.

However, effectively helping populations maintain their health is the final and vital leg of the Institute for Healthcare Improvement’s Triple Aim: reducing the per capita cost of health care. Couple this goal with the first two aims — improving the patient experience of care and improving the health of populations — and the Triple Aim serves as a blueprint for creating a sustainable, true health care system that improves quality while managing costs.

Baylor Scott & White Quality Alliance is committed to achieving the Triple Aim and controlling the cost of health care. Take a moment to watch the video above about how we are doing it.

Waste not, want not

In a previous post, I discussed the tremendous amount of waste in health care and the reasons for it, citing Donald Berwick, MD, the former administrator of the Center for Medicare and Medicaid Services (CMS) and former head of the Institute for Healthcare Improvement.

Dr. Berwick estimates at least 20-30 percent of health spending is wasteful, accounting for nearly a trillion dollars each year.

BSWQA is on the front lines when it comes to battling waste, whether it’s in the form of:

  • Too much care – prescribing treatments of little or no added value, such as overly intense, futile care at the end of life
  • Too little care – failing to provide preventative care, such as immunizations or colon cancer screens
  • Wrong care – preventing errors in treatment

A proactive approach is a critical component of eliminating waste. Up until recently, an annual wellness exam generally wasn’t covered by insurance or CMS. An annual wellness exam is critical to uncovering potential health problems in their earliest stages before they become worse and more expensive. Early intervention for chronic disease has been shown to lower costs.

However, just because a wellness exam may be covered, getting patients — especially men — to visit a doctor can be a challenge.

Identifying trouble ahead

Consider our patient, Mr. Jones, who was featured in parts 1 and 2 of this series. Mr. Jones is a 60-year-old smoker with diabetes, diminished kidney function and chronic lung disease. He has survived a heart attack.

If the model of care BSWQA is creating had been around 20 years ago, and had Mr. Jones been a patient, he would have received a call from a BSWQA nurse care coordinator or scheduler reminding him that he needed to come in for his annual wellness exam.

The care coordinator or scheduler would explain the importance of the exam and help him overcome any issues with making an appointment.

During Mr. Jones’ wellness exam, the BSWQA physician member may have uncovered that he had pre-diabetes, as well as high blood pressure. The physician and team would have also known that Mr. Jones was a smoker. Even though Mr. Jones may have felt fine, his risk factors would have led to a number of interventions that could change the course of his life:

Intervention: He would have been put on a diet and exercise plan to lower his risk of developing type 2 diabetes.
Result: He doesn’t develop type 2 diabetes or diabetes-related complications, such as diminished kidney function.

Intervention: He would have been given a prescription for a medication to control his blood pressure.
Result: Along with his healthier diet, he never has that heart attack.

Intervention: Mr. Jones knows smoking is bad, but doesn’t know how to quit, until his physician and BSWQA nurse care coordinator enroll him in a smoking cessation program.
Result: He never develops chronic lung disease.

An ounce of prevention

The overall result for Mr. Jones is avoiding decades of struggles with his health. For the health care system, it is avoiding the significant expenses of caring for Mr. Jones as his health deteriorates.

BSWQA’s population health management efforts are not just about catching problems early, but also about empowering people to take control and own their health. Every Mr. Jones whom BSWQA is able to put on the right path before they end up with multiple chronic diseases saves more than enough money to cover wellness, prevention and care for an entire population.

We have a long way to go, but payors, employers and CMS are realizing that one critical way to reign in per capita health care costs is through preventative care that leads to global savings.

About the author

Dr. Carl Couch
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Dr. Couch currently serves as President of the Baylor Scott & White Quality Alliance, an integrated network of more than 3,700 physicians, 43 hospitals, 31 surgery centers, 29 skilled nursing facilities, 10 home health agencies, three hospices and additional points of care aligned with Baylor Scott & White Health.

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Financing health care, not sick care, the BSWQA way