The Quality and Cost Council held its annual meeting yesterday in Shrewsbury, MA. A good crowd turned out for the event which included a keynote address by Cathy Schoen from The Commonwealth Fund and a responding panel made up of Senator Richard Moore; Dr. Charlotte Yeh, formerly of CMS and now with AARP Services, Inc.; Dr. Randy Wertheimer of Cambridge Health Alliance; and Eileen McAnneny of Associated Industries of MA. You can find meeting materials, including Ms. Schoen’s presentation, on the QCC website.
A few facts from Schoen’s presentation that have been public previously (many came from Commonwealth Fund reports from 2008) but still are shocking to see: In the U.S., 34% of patients with chronic conditions reported that they experienced medical errors, medication errors or lab errors in the previous year, a figure that was higher than other countries studied; U.S. patients are less likely to see a doctor quickly when needed and more likely to go to the E.R.; only 40% of providers in the U.S. have arrangements for after-hours care while 95% do in the Netherlands (thus, leading to E.R. use).
She talked about some of the examples in the U.S. of health systems doing innovative practices, like the medical home model at Geisinger in rural Pennsylvania. Because it is in a rural area, there are many small providers’ practices spread out. So they use nurses who work with multiple practices and help with managing the care of elderly and frail patients. This decreased the use of the ER and hospital admissions and also decreased costs. While MA rates highly in terms of access and quality, the Commonwealth stands out in its high ranking on numbers of potentially preventable hospital readmissions and hospitalizations for ambulatory sensitive conditions (things that should be taken care of outside of the hospital). This speaks to the need to do more work on discharge planning and transitions of care and improving communication across providers and with patients.
The panelists all had interesting comments but the one that struck me the most was the piece of Dr. Yeh’s talk when she mentioned areas where we should look more for improving quality and reducing costs. She said that there could be savings of $50-75 billion if health literacy issues are addressed. She also talked about Alzheimer’s and depression/mental health and said that costs for care related to depression can be reduced 50% if it can be managed from home rather than the hospital. Dr. Wertheimer talked about the need to follow evidence-based medicine more often and gave the example of the use of electronic fetal monitors and that they don’t need to be used with low-risk pregnancies. She also talked about guidelines for mammograms and whether women age 40-50 who are low-risk need them annually.
The presentations were followed by small group discussions on quality and cost measures that should eventually be included on the website. Congrats to the QCC for putting together a stimulating program and for including the audience in discussions.