Category Archives: Fragmented system

Changing Expectations in Healthcare

What follows has been excerpted from a new paper, “Changing Expectations in Healthcare,” by Milliman Principal Jon Shreve.



Widespread evidence that our healthcare system is in need of substantial reform continues to mount. Most of this agreement centers on issues of access to affordable health insurance, the need to improve the quality and efficacy of care, and the costs associated with our present system. In order to achieve meaningful reform, a solution must address all three problems.



Of course this is easier said than done. While there may be general agreement on common goals for healthcare—increased access, improved quality, and reduced costs—there is no such agreement when it comes to how we accomplish these goals. If comprehensive healthcare reform is to occur, it should start with a clarification of the fundamental expectations for those involved in healthcare, and then incorporate policies designed to meet these fundamental expectations. Such expectations can help the healthcare system coalesce around interrelated responsibilities for patients, for care providers, and for payers.

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The quality challenge

The third systemic problem with the current system–alongside cost and access–is of course quality. Just look at where the U.S. ranks alongside other systems in terms of outcomes and the problem becomes clear. These quality problems can be traced to a variety of sources, as outlined by Ron Harris and Clark Slipher:

Our present quality-related shortcomings, coupled with the comparatively high level of spending on healthcare in the United States, point to a healthcare delivery system that, as a whole, is not performing effectively. Some of this failure is patient and lifestyle driven; some is provider, supplier, and technology driven; some, reimbursement-structure and payer driven; some, government, litigation, and regulation driven—and almost all of it is affected by incentives that are often not productively aligned among the parties or structured to promote optimal performance.

We’ll be offering solutions to these problems in the coming weeks.

Veterans Administration builds on electronic record system

President Obama today announced an effort to computerize the medical records of all military personnel and better integrate records between the Defense Department and the Department of Veterans Affairs. This is a complicated issue, as was made apparent during tonight’s PBS coverage of the announcement:

The proposal builds off of an existing infrastructure. The VA has a robust electronic health record system in place already, as Gail Graham discussed at the EHR Town Hall in December:

Mental health and the ER

A report out of Texas indicates that nine patients in the Austin area accounted for 2678 emergency room visits at a cost of $3 million during the past six years. The causes were not always certain, though seven of the nine have a mental health diagnosis. One doctor at least thinks these diagnoses explain some of the ER visits.

Dr. Christopher Ziebell of University Medical Center at Brackenridge sees many people in the ER who aren’t having emergencies. With mental illness, he said, ‘a lot of anxiety manifests as chest pain.’

We know that mental health, when not treated properly, can be quite expensive. Mental health parity expert Steve Melek has testified before Congress and conducted research on how mental health can pair with other chronic conditions in highly-expensive comorbidities. The recent passage of mental health parity legislation may help mend fractures in care among the insured. But confronting this problem among the uninsured remains a thorny issue.

“16 to 12” featured, discussed on The Health Care Blog

The latest post at The Health Care Blog features an article by Bruce Pyenson, Kate Fitch, and Sara Goldberg about their recent healthcare reform report, “Imagining 16% to 12%,” which provides an actuarial yardstick for health reform proposals and efficiency targets for the US healthcare system.

Congress delves into the intricacies of healthcare costs

Milliman experts and their research are increasingly a part of Congressional discussions of healthcare reform. On Tuesday, AHIP President and CEO Karen Ignagni cited research by Will Fox and John Pickering in her testimony before the Senate Health, Education, Labor and Pensions Committee:

A December 2008 study by Milliman, Inc. projects that this cost shifting essentially imposes a surtax of $88.8 billion annually on privately insured patients, increasing their hospital and physician costs by 15 percent. This study concluded that annual health care spending for an average family of four is $1,788 higher than it would be if all payers paid equivalent rates to hospitals and physicians. The transfer of these costs to those with private coverage cannot be sustained and is critical to addressing concerns over affordability.

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