Lessons From Abroad: International Efforts to Improve Quality, Reduce Costs and Increase Transparency Robert S. Galvin, MD Bipartisan Congressional Health Policy Conference January 13, 2007
Lessons From Abroad Where The U. S. Is Different • Much Larger, More Heterogeneous Population • Health System Much Less Centralized…By Design(? ) - Federal vs. State vs. Private Sector • No Consensus On How To Control Costs • Very Medical Innovation-Technology “Friendly” Where The U. S. Is Most Similar • Common Belief: Driving Value vs. Cost Containment 2 Robert S. Galvin Bipartisan Congressional Health Policy Conference January 13, 2007
U. S. Has Been Improving Quality…Slowly 3 Robert S. Galvin Bipartisan Congressional Health Policy Conference January 13, 2007
Strategic Framework Board - 2003 Purpose Goals PATHWAY #1 Results (Performance) Selection + Payment Consumers Purchasers Patients PATHWAY #2 Improvement Professional Organizations Motivation Care Delivery Teams 4 Robert S. Galvin Bipartisan Congressional Health Policy Conference January 13, 2007
The Power Of Transparency Hospital Death Rate (RAMR) Columbia Presbyterian 3. 93* Lenox Hill 2. 26 NYU Hospitals Center 1. 95 Weil Cornell – NYP 0. 95* Surgeon RAMR State Total 2. 25 Smith, C 4. 15
Payment and Improvement Institute of Medicine (2001) Med. PAC 2004 (2004) “Purchasers should…Remove “Current Payment Barriers that…Impede Quality Systems. . . Are at Best Improvement Neutral and at Worst And Build In Stronger Incentives For Quality Enhancement” Negative Towards Quality” Glen Hackbarth “If I keep getting better, Dr Galvin, I’m going to improve myself right out of business” 6 Robert S. Galvin Bipartisan Congressional Health Policy Conference January 13, 2007
Health Costs: Lots of Opportunity, Little Focus Immutable & Desirable Ageing Technology Cultural Unhealthy Lifestyles Malpractice End of Life Care System of Care Uninsured Administrative Costs High Prices/Specialist Incomes Waste and Quality Shortfalls Lack of Accountability/Transparency
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