Costs and Quality of Health Care A Twisted Relationship I

Quality and Costs: A Twisted Relationship L. Gregory Pawlson MD, MPH, FACP Executive Vice President NCQA Costs are and have been increasing at an UNSUSTANABLE rate Long Term Health Cost Trends Healthcare Costs as a PERCENTAGE of GDP 100 90 80 70 60 50 40 30 20 10 0 19 50 20 00 20 25 20 50 21 00 GDP % Healthcare GDP Quality is not so great either! Growing Evidence that Value of Health Care is Far from Optimal • The “old” RAND study- lack of relationship between volume and appropriateness (Brook et al) • Patient safety studies-up to 100,000 hospital deaths due to errors and avoidable complications (Brennan, IOM) • Evidence from current measurement: less than 50% of diabetes, hypertension or asthma treated optimally with existing medications (McGlynn et al) Growing Evidence that Value of Health Care is Far from Optimal • Documentation of wide variation in rates of use of treatments and lack of relationship between quality and quantity of services (Wennberg et al) • Over 25,000 deaths avoided each year if under treatment level raised to achievable benchmarks (90% tile of highest performing health plans) (Eddy-Archimedes, NCQA State of Health Care) Summary of Findings • There are substantial opportunities for improved care • Appropriateness and volume of services do not appear to be closely related • Rate of increase of costs IS a problem that should concern everyone • Quality and the quantity of services and cost of care provided do not appear to have simple direct relationship (? Inverse at this point) What should a “value based” Health Care Do? A: Move people from “Right to Left” —and keep them there Current Health Care Spending Ideal Spending 20% of people generate 80% of costs A value-based health care system Source: HealthPartners Challenge: What do we know about the relationship of cost and quality-and what can we do to optimize value?