On July 10, the Center for Medicare and Medicaid Services (CMS) announced an agreement with Premier, Inc. that begins the next evolution of the health care system in America. Premier is the leading health care alliance collectively owned by more than 200 independent hospitals and health care systems in the U.S. Methodist is an owner.
CMS’ agreement with Premier will launch its Medicare Waiver Demonstration Project, which will use financial incentives to encourage hospitals to continuously improve the quality of their inpatient care in five clinical conditions: heart attack, heart failure, hip and knee replacement, pneumonia, and coronary artery bypass graft. Methodist has agreed to volunteer to help define the standards for outstanding performance in these measures.
This significant step by CMS closely follows the March 25 symposium in Peoria, highlighted by Dr. Regina Herzlinger. Her books, Market Driven Health Care (1999) and Consumer Driven Health Care (2002) are now the foundation for the consumer driven movement in health care.
The premise Dr. Herzlinger has been promoting for several years-and for which she appears to be gaining support throughout the country and central Illinois-is consumers can drive significant and meaningful change in the American health care system if they’re provided more information about the quality and price of health care. With this information, people will make health care decisions that are in their own best interest and meet their own needs.
Dr. Herzlinger’s premise has merit. Very little quality information is known about health care. There’s very little standardization or clearly defined outcomes. Only 3 percent use quality as a guide in making their health care decisions.
CMS’ attempt to educate and provide standardized quality data, where comparisons can be made, is a huge step toward transforming the health care industry. When the American consumer has knowledge, industries have changed to accommodate the American consumer.
In the health industry, many questions need to be answered. Will consumers take the time to be educated and learn about the intricacies of the health care decisions they’re making? Will consumers use quality in evaluating where to get their health care in the future? Will people look at more than just price to determine what’s the appropriate value of their lifestyle and status they wish? Will employers change to allow their employees greater flexibility and become less paternalistic in their approach? Will employers ever look at something other than price?
Clearly, employees are going to demand greater flexibility as they pay more out of their own pockets for health care. It’ll be years before we know the answers. As a health care provider, it’s very disheartening to have to compete solely on price.
If consumerism doesn’t lead to a better system that enhances the quality of life while stabilizing costs, the primary alternative is a government-run health care system. Unless consumerism in health care dramatically changes the industry during the next 10 years, we’ll all be talking about a national health care system. IBI