A special communication by Papanicolas et al. recently published in JAMA finds that the U.S. continues to lead other high-income countries in terms of healthcare spending. The authors also stated that, as compared with the 10 other high-income nations included in the study, the U.S. has:

  • The lowest life expectancy (78.8 years)
  • The highest percentage of overweight or obese adults (70.1 percent)
  • The highest infant mortality rate (5.8 deaths per 1,000 live births)

The report, which was based on an analysis of data from 2013 to 2016, also calculated that the utilization rate for medical care in the U.S. is similar to the other countries, but U.S. spending is approximately twice as much, primarily due to higher costs for labor, pharmaceuticals, and healthcare administration.

Unfortunately, the U.S. healthcare spending/outcome issue is not a new concern. Many stakeholders, however, are optimistic that new value-based care models might be the answer to the cost/quality dilemma in the U.S. and lead to care that is more cost-effective and results in better health outcomes.

CMS, along with many private insurers, has been slowly rolling out value-based reward programs over the last 10 years, and today 47 percent of physicians have their compensation tied to quality and value, according to the 2018 Survey of America’s Physicians Practice Patterns & Perspectives. However, as evidenced by the study published in JAMA, we still have a way to go. I am optimistic that we’re heading in the right direction and that, in time, we will be able to bend the cost curve and improve patient care. Here’s why.


The policy factor

Despite the ongoing shift to value-based care, providers have continued to cling to the fee-for-service mindset of the past decades. Hospitals still rely heavily on filling beds or delivering ancillary services in order to meet revenue objectives, while payments for treating sick patients and for expensive procedures continue to represent the bulk of physician compensation. Government payers have taken the lead in forcing the switch to value-based plans, while private insurers – which cover over half of the population – have followed the government’s lead, albeit at a slower pace.

It’s worth reiterating that the Papanicolas et al. study was based on data from 2013 to 2016. As U.S. Department of Health and Human Services secretary Alex Azar recently noted, quickening the pace of the value-based payment transition is a major focus for the current administration, which recognizes that “today’s healthcare system is simply not delivering outcomes commensurate with its cost.” In other words, even though it’s human nature to resist change, the wheels are in motion for the value-based care transition, and we should expect an acceleration in the pace of change.


The pocketbook factor

Historically, a physician may not have thought twice about ordering a costly MRI if he or she felt it was warranted based on a patient’s condition. In a value-based care world, however, a physician is likely to be more cautious when ordering tests or procedures and might first evaluate what therapies align with known best practices. When compensation is based on quality and cost-effective outcomes, clinicians are more likely to avoid potentially unnecessary treatments in favor of therapies that are widely recognized to deliver high-quality, cost-effective care.


The technology factor  

The use and acceptance of technology standards in healthcare continues to grow, reinforcing my belief that we finally have the right elements in place to reverse our healthcare spending/outcomes trend. Consider, for example, technologies that provide clinicians with protocols and clinical decision support (CDS) tools to navigate complex care pathways and determine the ideal therapy for a given patient. Such tools have been available for years, but until recently, few EHR vendors have had the ability to deliver such solutions without disrupting clinician workflows–and clinicians are resistant to using any technologies that slow the delivery of care.

Today, however, open standards such as FHIR and CDS Hooks are enabling EHR vendors to introduce major system updates for their platforms without requiring years of development work. Clinicians can now take advantage of solutions that provide streamlined access to care protocols and CDS tools – as well as clinical content, analytics, population health data, and more – directly from within their existing clinical workflows. Physicians can gain real-time, point-of-care access to content that drives the creation of highly specific care plans that facilitate quality, cost-effective care, without compromising speed or productivity. With point-of-care access to CDS tools, evidence-based protocols, and other technologies, clinicians may even experience a boost in productivity.

At a high level, FHIR and CDS Hooks facilitate the creation of new entry points into EHRs – which have long been black boxes containing siloed patient data. Using an API, an EHR vendor can allow third-party solutions to work in the background, access critical patient data such as medications and problem lists, and deliver real-time information and recommendations that enhance clinical decision-making and the overall care process.

Fortunately, most EHR vendors recognize that clinicians need additional functionality within their workflows to help reduce overutilization and inefficient processes and to optimize patient outcomes. With FHIR, CDS Hooks, and other emerging standards, we now have the ability to deliver clinicians the tools they need, when they are needed, without compromising productivity or disrupting patient care.

Healthcare policy, provider reimbursement models, and technology have never been better aligned to affect change in the delivery of U.S. healthcare. By taking advantage of the current climate and opportunities, we have the ability to reverse spending trends and improve the overall health of the population.