By Ken Cohen, M.D., F.A.C.P
Chief Medical Officer of New West Physicians
Chief Medical Director, OptumCare
The United States spends $3 trillion a year on health care — three times as much per person as the average of other wealthy nations. At the same time, the U.S. performs worse than other developed countries on many health measures, with Americans suffering from more chronic conditions and living shorter lives. In fact, the average family now spends almost a third of its income on healthcare. This is neither fair nor sustainable and our patients have every reason to be upset by this.
“Waste” in healthcare
Numerous studies have shown that about one-third of all healthcare delivered in the U.S. is considered “waste” – that is, it doesn’t improve a person’s health or quality of life, and can sometimes even cause harm. Examples include unnecessary medical and hospital procedures, operations, and advanced imaging, such as CT and MRI scans. If collectively we are able to stop delivering this care that does not make people better, we will be a long way down the road to solving our healthcare affordability crisis. One way to achieve this goal is for health care providers and hospital systems to move to what is known as value-based care. This is where healthcare providers and hospital systems assume responsibility for the quality and total cost of care in their population of patients. Rather than care providers and hospital systems being paid for the quantity of services they deliver, they are paid based on the quality of care they deliver and patient’s actual health outcomes. The goal is to provide better care to people, improve the patient experience and reduce healthcare costs.
Optimal Care is the name for the care model that has been designed at New West Physicians to achieve this goal. The main idea behind Optimal Care is to rapidly bring the best in medical research to care providers so they can use it in their daily practice with their patients. By doing so, the care that we deliver is proven to improve health outcomes, minimizing the delivery of wasted care.
We use a process with our patients, known as shared decision-making, where we try to predict the outcomes of medical and surgical interventions and help our patients make the best choice about the care that best matches their goals and preferences. As an example, let’s look at prostate cancer screening. Many prostate cancers are slow growing and will never grow to cause any problems. For every 1,000 average risk men between ages 55-69 who get screened for prostate cancer:
- 240 will have an abnormal screening result
- 100 will have a positive biopsy for prostate cancer
- 80 will choose surgery or radiation for treatment of the cancer
- 1 patient will avoid death from prostate cancer and 5 will die despite treatment
Looking at these results, some of our patients will choose screening and others will not. There is no right answer. The key is being armed with the information necessary so each person can make their own best choice.
When important in the decision-making process, we also will share costs of care with our patients. This can have a huge impact on reducing a person’s overall and out of pocket health care costs. For example, the same operation done at the hospital may be 300% more costly than if done at a surgery center.
Additionally, with Optimal Care, we coordinate the care of our patients with specialists, who have been chosen based upon the quality of care and service that they provide. New West Physicians hospital physicians, care managers, social workers, and nurses follow all of our patients no matter where they are getting their care to keep close tabs on the quality of care that they are receiving.
Given the gridlock in Washington, the likelihood of a fundamental redesign of our healthcare system is small. Therefore, solving our healthcare affordability crisis involves everyone, including both recipients and providers of healthcare. If you have questions about Optimal Care and what it means to you, talk to your care provider.