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The ticket to cheaper healthcare

MASSACHUSETTS leads the nation in many desirable categories. Unfortunately, one of them is per capita healthcare expenditures. The latest solution being proposed is for employers to shift more healthcare costs onto consumers to enlist their help in controlling medical inflation. While this may appeal to employers stunned by repeated years of double-digit premium increases, it is by no means sufficient to address the problem.

Deflecting the spotlight to consumers merely diverts attention from the real action. If large corporations, health plans, and health systems cannot succeed, why should we believe individual patients, particularly in vulnerable moments, can pressure the system to reduce spending?

To truly address rising healthcare costs, healthcare providers and health plans need to make fundamental changes, but they have proved unable or unwilling to do so. Even though we have made amazing strides in technology (such as new drugs, surgeries, and tests), we deliver this care to patients using a 19th-century delivery model. For instance we put up many barriers to patients communicating with providers; our care is largely reactive and not proactive; we focus too much on treatment and not prevention, and too often fail to use even simple information technology to make care safer and more effective. It is this model that is structurally unsound and one of the main drivers of escalating costs.

Although we have several world-class health systems in this area, they have little reason to innovate. Their practices are full; they mostly make money; and like most large bureaucratic organizations are relatively risk-averse. Other industries have proven that the sort of deep innovation we need is rarely delivered by the large, established players. Their interest is often in preserving the status quo. It is almost always small, nimble, hungry upstarts that create radically new ways to do things that are then adopted by all. Innovation in healthcare will occur in the same manner, if the environment is right.

For the past several years, I have worked on a project to create a radically better model of care. A model that would result in both increased healthcare quality and decreased costs. Based on research conducted through the Harvard Interfaculty Program for Health Systems Improvement, we have built an innovative primary care practice called Renaissance Health located on the Arlington/Cambridge border. By leveraging the most advanced information technology, empowering patients to play a much bigger role in their own care, and changing our paradigm of care delivery, we are building a new model to deliver better and more affordable healthcare.

Unfortunately, a few large payers, like Harvard Pilgrim Health Care, the second largest in the state, have put in place barriers to such innovation that almost preclude such necessary experiments from taking place.

Our practice provides a host of services that patients want (such as direct access to their doctor, proactive care, use of advanced information technology, access to their own medical records, and the ability to securely e-mail their doctor) but health insurers won't pay for. We have asked our patients to fund the cost of innovation by paying a small membership fee ($20 to $40 per month), which they do gladly. Our bet is that by delivering care in the right way, we will be able to save much more than this in overall costs by keeping people healthier. Yet Harvard Pilgrim, for example, refuses to let its HMO patients join our practice because of this membership model. While the intent is to deter so-called concierge practices, it effectively freezes in place our current delivery model, which we all know is fundamentally broken.

While we like to claim that our healthcare is the best in the nation, the truth is that it is only the most expensive. Simply shifting this burden to consumers will not lower costs by themselves. We need to change the delivery system in ways that improve patient access, involve patients in their own care, ensure quality, and control costs.

Instead of shifting the blame and diverting attention, we ought to be creating the environment to support and encourage such innovation.

Rushika Fernandopulle is a physician at Massachusetts General Hospital and a founding partner of Renaissance Health.

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