The federal government is headed in the wrong direction when it comes to healthcare, according to Don Berwick, MD, the founding CEO of the Institute for Healthcare Improvement, a medical industry think tank.
Berwick, who was keynote speaker at the Horizon Blue Cross/Blue Shield of New Jersey’s fifth annual Patient-Centered Summit on October 5, told the audience “We now have a government that is threatening the care of the most vulnerable among us [by trying to eliminate the Affordable Care Act] and that will cause tremendous harm, and we should not tolerate it.”
At the summit, Horizon emphasized its commitment to providing value-based healthcare to its customers. Horizon has become the state’s largest health insurance provider with 4,500 primary care physicians and 1.5 million members in its network. Roughly 45 percent of its business is through Medicaid.
Allen Karp, Horizon’s senior vice president of healthcare management, told the audience of roughly 500 healthcare providers that the company’s commitment to value-based healthcare “puts us in a position to strive to lower cost and deliver better care and great patient experiences.”
Berwick, the former head of the national Centers for Medicare and Medicaid Services, is widely respected as one of the nation’s top advocates for improving the healthcare system. He recalled a paper he co-authored several years ago that analyzed waste in American healthcare spending. That paper concluded that 34 percent of the money that consumers spend on healthcare is wasteful. It also concluded that generally, hospitals and healthcare providers are wrought with fraud and abuse in their billing systems; overuse treatment methods and overcharge for administrative costs.
He recalled a vacation with a friend two years ago as a real life example of waste in the healthcare system. His friend had a pre-existing heart condition and went to the local emergency room for a pain in his neck. Berwick recalled waiting with his friend for four hours before being cleared by a physician who concluded that he just had a neck sprain.
“A few weeks later my friend showed me his bill – it was $7,358 – and he said ‘I don’t understand, they didn’t do anything,’” Berwick said. “That bill was a travesty and the result of a system that snared both the doctor and the patient. The bill included dozens of checks that were standard for a hospital, but the physical examination was non-existent. The doctor ordered a chest x-ray that ended up costing 10 times what it should have,” he said.
That bill, Berwick said, “is one small symptom of a system that has gone off the deep end.”
He said that the country needs to usher in a new era of healthcare that should focus on service, not production and outlined nine steps to make that reality.
“We live in the tension between the beauty of healing and the best of care as production. I think that tension is erosive and, if we’re not careful, it could break us,” he said.