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"The two words ‘information’ and ‘communication’ are often used interchangeably, but they signify quite different things. Information is giving out; communication is getting through." -- Sydney J. Harris

Lessons from National Physician Leadership Seminar on Total Cost of Care

In mid-August, MNCM invited two Minnesota physicians to participate in the first National Physician Leadership Seminar focused on Total Cost of Care, which was sponsored by the Network for Regional Healthcare Improvement (NRHI). Dr. Lori Bethke, MD, a family medicine physician with Entira Family Clinics, and Dr. David Satin, MD, a family medicine physician with University of Minnesota Physicians and assistant professor at the University of Minnesota’s Medical School, attended the seminar at Stanford University.

“With health care costs consuming the U.S. economy, physician leaders are pivotal to changing this trajectory,” said Elizabeth Mitchell, President and CEO of NRHI.

Along with Drs. Bethke and Satin, 14 other physician leaders from Colorado, Maine, Missouri and Oregon participated. The seminar curriculum featured Dr. Arnold Milstein leading a discussion on the motivation around Total Cost of Care measures; learning sessions on creating transformational change and being physician champions; and a sneak peek at new Stanford University research on clinics that consistently rank high in quality and low in cost.

“Total cost of care is a major problem for our society, not just for health care,” said Dr. Satin. The seminar helped him better appreciate “the context of everything that’s being impacted by the amount we spend on health care,” because our society then doesn’t have funds for other important priorities, such as education, defense and Social Security. “We just don’t have the money to do it all.”

The concern is warranted. The United States spent $2.6 trillion on health care in 2010; and the share of economic activity (gross domestic product) devoted to health care has increased from 7.2% in 1970 to 17.9% in 2009 and 2010, according to the Henry J. Kaiser Family Foundation. These increases are outpacing wages and spending on other goods and services, which impacts households, businesses and government.

While a total solution will require significant health care financing questions to be answered, “there is a wide swath of things [doctors] can do today,” according to Dr. Satin. One is eliminating unwarranted variation in care, particularly when it has a neutral impact on providers and a positive impact on patients and/or society. For example, prescribing generic drugs. There is minimal to no negative for medical groups to prescribe some generic medications more frequently, but there is a large positive impact for patients and society in the overall cost of health care.

If medical groups identify wide variation in care, Dr. Satin said doctors at that practice need to get together evaluate the variation in care and determine the best practice. “We need to start these conversations,” he said. “The unsustainability of the current system makes it clear that there are social and moral imperatives to do cost effective care that doesn’t impact quality.”

Dr. Bethke echoed that sentiment. Entira “uses the data to try to improve our referral utilization,” she said. For example, they have streamlined internal processes to make referring patients needing mammograms to the most cost effective option as easy as possible. Additionally, they utilize data to identify patients who need more care and have programs in place to provide additional coordination between clinic visits to help them stay healthy, she said.

These conversations amongst doctors will also make medical groups and doctors more prepared when the big health care financing questions are answered.

“Not paying attention to unwarranted variation in care is hurting our society,” Dr. Satin said. “It’s going to take doctors [championing cost containment] to convince other doctors…. because we know where the sticking points have been.”

Both Drs. Satin and Bethke agree Total Cost of Care measures, including the one MNCM hopes to publicly report later this year, are an important place to start. “How can we refer patients to the best quality for the lowest cost if we don’t know this data?” asked Dr. Bethke. “[Total cost of care] will start to tell us where variation might exist,” agreed Dr. Satin.

MNCM will release Total Cost of Care reports to all included medical groups this month. Our intention is to publicly report portions of the information later this year, following medical group review and consideration by MNCM’s Measurement and Reporting Committee. If successful, it will be the nation’s first publicly reported Total Cost of Care measure.

The seminar is part of NRHI’s Total Cost of Care pilot – which MNCM is participating in – that will produce actionable, practice-level reporting to enable identification of the drivers of regional health care costs and development of strategies to reduce spending at a community level. MNCM is partnering with four other communities to develop a common measurement standard of total cost and resource use.