Editor’s note: This op-ed is by Anya Rader Wallack, the chair of the Green Mountain Care Board.
I chair the Green Mountain Care Board, which is responsible for reducing health care cost growth in Vermont by changing health care payment and encouraging change in health care delivery. We are charged with making sure that cost containment results from real efficiencies, not arbitrary constraints.
When I speak with health care practitioners around the state, I try to make three central points:
•Significant transformation in our health care system to reduce cost growth is absolutely necessary and unavoidable;
•Doctors and other health care practitioners must lead this transformation, or we will get it wrong, and;
•Health care providers can’t tackle this challenge alone. State government, the federal government, hospital administrators, private payers and patients have to be part of the solution. Vermont has to embrace changes in health care delivery as a community.
Health care costs rise, in Vermont, at two to three times the rate of growth in the economy. That trend is impossible to sustain. We currently spend about one out of every five dollars we earn on health care, and we spend more with each passing year. If health care costs continue to rise at five percent per year (a reasonable expectation) and the state economy grows at two percent per year (also reasonable), health care costs would absorb 100 percent of gross state product around 2045.
This concept is ludicrous: We could not spend all of our income on health care. As with a family budget, we, as a state, have to buy food, housing and all other things that are essential. Yet we have seen the effect of rising health care costs on our spending. A recent Health Affairs article documented that, between 1999 and 2009, Americans, on average, gave up all real increases in their incomes to health care costs.
We won’t let it get that bad. The question is how will we stop it? If history is a guide, Medicare and Medicaid use the only tool that has any meaningful impact – provider fee reductions – to moderate overall health care cost growth. Public and private payers also will try to influence health care use, by requiring providers to ask for permission, requiring them to file paperwork, or second-guessing their decisions. That’s not the right way to reduce health care costs.
This is why providers must lead in crafting a solution. Health care practitioners have to own this one, and we must develop reforms that enhance their role in the health care system, which has been sadly diminished in recent years. They know there are better ways to reduce health care cost growth. Not easier, but better. There is avoidable hospital use. There are avoidable readmissions. There is better management of chronic conditions. There are better approaches to end-of-life care.
We know that, when doctors provide evidence-based care to patients, costs are reduced and quality is enhanced. The current system constrains them from providing evidence-based care – it forces providers to shorten visits, refer the patient up the line, or order stuff they might not think is necessary. Both the reimbursement system and the liability system encourage this.
Health care providers cannot do this alone. They need support and cooperation to change the health care delivery system, to make it more efficient and effective. They need public and private payment policies that pay fairly for doing the right thing. They need hospital administrators who support them. And perhaps most importantly, they need patients whose expectations and personal behavior are consistent with a system that rewards value. This is difficult to achieve, but essential to our success, as a community – a full community, not just a medical community – at health care reform.
Our goal, as a board, is to create an environment – in terms of payment, regulation and public policy – that supports health care practitioners in creating the best possible health care system for Vermont. To say we need their help in this endeavor would be an understatement – we need them to lead it.
