Colorado's Blue Ribbon Commission on Health Care Reform - 208 Commission - Needn't Act In Haste

As the year progresses and the 208 Commission pursues its lofty and noble goal to discover the secret to quality accessible affordable health care for all Coloradans, the stakes continue to rise. It would be difficult if not impossible to find an informed person who does not agree that a crisis exists, and that a solution is needed. However, that does not mean that the 208 Commission should rush this process simply to say that they did something about it. It also goes without saying that taking the wrong steps at this time will exacerbate the problem leaving us with an even higher price to pay.

The central issue we face in addressing the health care system's woes is identifying the root cause of the problem. It would be simple for us to point fingers at the isolated activities of health care providers, the government, employers, patients, attorneys, or any other system participant. It may be more fruitful for us to look at the structural elements of the system that drive their behavior to identify what needs to be fixed to improve the quality of health care thereby lowing its cost and making it not "universal", but "universally affordable". In other words, those who want it would be able to inexpensively purchase it, and those who do n0t want it would not be forced to have it.

Too many of the system participants I have identified above consider treatment to be the product or service of health care. The fact is, good health is the product, and good health is less expensive than poor health. Building consensus around this fact is the foundation of the solution to the problem. When that is done, we can then start the good, but difficult work, of focusing all system participants' behaviors on maximizing value at the point of patient care (i.e., getting them back to optimal health as quickly and inexpensively as possible). All financial incentives should be centered on rewarding providers who are able to bring the most value to the patient at this level. All other current incentives and ineffective processes should be systematically ended – and too many of them exist today.

In order for us to base incentives and rewards on maximized value, we will need to come to an agreement on and commit to: (1) the methodology and uniform application of health care costing techniques, (2) fairly developed risk-adjusted outcomes metrics, and (3) the form and accessibility of this information to everyone. How else can patients, employers, health plans, health care providers, or any other interested party evaluate results for purposes of selecting, rewarding, encouraging providers to make quality improvements, or if necessary avoiding ineffective high cost providers?

Historically health care consumers have not shopped for health care based on results. They have taken the attitude that all health care is the same, or worse, that more costly health care is better health care. When you peel back the proverbial layers of the health care onion, you quickly see that when health is defined as the product and all system participants act to maintain and improve health, that the current level of spending on health care becomes unnecessary. Medical technologies and processes that bring little or questionable value cannot endure when patients have relevant facts and an understanding of how to apply those facts in the face of the complexities of health care decisions.

If this sounds overly simplified to you, it may be because for years we have overcomplicated this issue by addressing obvious cost-drivers as they have emerged instead of the focus and structure of competition in health care itself. We all win when patients direct themselves, or are directed, to providers who maximize patient value through their focus and experience across the entire cycle of care for specific medical conditions. Until we all have access to the kind of information that drives providers to this level of focus and quality we will continue to lose money to this problem. Mandating universal health care without fixing the system through which it is delivered only magnifies the problem.

In the end, the 208 Commission has a responsibility to not act out of a self-created feeling of necessity, but out of informed judgment when the time is right. Clearly every proposal they receive will contain well-made cases and demonstrated facts. When those facts and resulting proposals are run through a filter that determines if they directly or indirectly increase or maximize the value of care at the level of treatment of a medical condition for a patient, it will become apparent if the recommendations should be followed or not.

I sincerely hope the members of the 208 Commission will incorporate this thinking into their decision making process, and will not allow their stated goals and arbitrary deadlines to take on a life of their own leading them to making premature recommendations to the legislature. The stakes are too high and we all stand to lose too much if that happens.