U.S. health care: A Model T in a Tesla world?
This is not sustainable. It doesn’t work for the people and families in need of care or for the employers and others who carry the burden of paying for that care through insurance..
As a physician and the leader of a health system, I would say the status quo also isn’t sustainable for us. This is particularly true in New Hampshire, where even as the number of Medicaid patients we see increases, the reimbursement decreases.
Because of the state’s Medicaid Enhancement Tax and other factors, Dartmouth-Hitchcock essentially pays New Hampshire to take care of the Medicaid patients who need our care. That’s definitely not sustainable.
Nor is it right or fair for the people of New Hampshire, neither the patients who have an increasingly difficult time finding providers willing to take Medicaid patients or the private payers — generally employers — whose insurance rates often go up to help fill the gap.
So what’s the answer? I think there are three pieces to creating a sustainable health (not health care) system that will be here to improve the lives of the people and communities we serve, for generations to come:
1. We need to focus on the health of our people, not market share for providers;
2. We need to provide value — as businesses have always done if they are to be successful — and be rewarded for quality and results, rather than the volume of procedures we do;
3. And we need new payment models that move us away from fee for service, a system with the wrong incentives, that only encourages providers to do more, with the result that patients receive unnecessary — sometimes harmful care — and that health care costs continue to spiral upward.
In achieving these aims, I would argue that relying on government alone is the wrong path. Government has a role to play, certainly, but if we’re to get the kind of innovation and ingenuity that produced the Model T and the Tesla, we need a broader effort.
I believe New Hampshire has an opportunity to create its own future for health care, with business leaders and health care providers working together with insurers, community organizations and others. I’m glad to say that health systems are already having these conversations. Dartmouth-Hitchcock is working with hospital CEOs across the region on how we can innovate together for the benefit of patients.
An example of this kind of partnership is ElevateHealth, the insurance product we have created with Elliot Hospital and Harvard Pilgrim. This product, which initially will be offered to the business community, provides coverage with premiums that are 10 to 15 percent lower than market.
Dartmouth-Hitchcock is also a founding member of the national High Value Healthcare Collaborative, an initiative that now has more than 20 member health systems nationwide, with more than 75,000 providers in 38 states and 100 million patients from all 50 states. We are working together to apply tools that will be familiar to anyone in business to arrive at best practices and spread those to other institutions in order to raise quality, improve value and lower costs.
With other business partners — regional and national — we are providing care directly to employees, wherever they are, through tele-medicine. Another initiative allows us to provide primary care to employees on-site, at their business, at significantly lower cost. We are also working with CVS MinuteClinic to open new walk-in medical clinics that will be an additional resource for the underserved and often uninsured members of our communities.
These are just some examples of what we can do when we reach across disciplines and work together to develop and apply new models and solutions. I encourage employers and others to join the conversation. Together, we can create a sustainable health system and make New Hampshire a model for the nation!
Dr. James N. Weinstein is a spine surgeon and CEO and president of the Dartmouth-Hitchcock health
