State of the Industry 2011: Quality & Costs

Care management often beats out financial incentives as the single most popular tactic for improving quality and controlling costs.

"This shows a concern with the financial component, but the paramount concern is the clinical management of patients," says Paul Setlak, PharmD, MANAGED HEALTHCARE EXECUTIVE editorial advisor, who serves as regional clinical executive for managed care for Abbott Labs in Chicago.

Setlak suggests that's because payers and providers are less familiar with and have less experience with the newer financial tools, such as bundled payment.

The stimulus package provided more than $1 billion in federal support for comparative effectiveness research (CER), which has the potential to improve clinical decision making and provide evidence of value among healthcare treatments and services.

One reason payers in particular may be cautious about comparative effectiveness research, Setlak says, is because it could increase medical spending by documenting that more expensive therapies yield better long-term outcomes and therefore will be seen as more cost-effective.

"CER is one of the most important areas of healthcare reform," Setlak says. "But payers and providers don't know how it will be carried out and whether it will be conducive to maintaining proper patient outcomes."

DMAA: The Care Continuum Alliance, in collaboration with RAND, is currently in the developmental stages of a comprehensive, industrywide data repository to inform the CER process. The repository will include data from population health management stakeholders, including plans, wellness programs and provider systems.

When it comes to health IT, providers are concerned about workflow changes. The amount of time it takes to enter patient information in electronic medical records, for example, could decrease time for patient care, Setlak says.

It may take awhile, but most providers eventually will become more comfortable with these newer approaches to quality improvement and cost control, just as they warmed up to electronic prescribing.

"Initially doctors were very hesitant about e-prescribing because there wasn't much known about it in terms of safety and accuracy," he says. "But these days e-prescribing is one of the most rapidly expanding segments of healthcare IT. It's going back to that fear of not knowing what's out there."

Currently, seven of 10 deaths among Americans each year are caused by chronic diseases, which also account for more than 75% of the nation's healthcare spending, according to HHS. Chronic disease management and prevention clearly remain the areas in most urgent need of improvement in order to contain costs.