Shannon Brownlee
Evidenced-Based CarePanelists agreed that healthcare was one of the few industries that has not been consistently using
evidence-based practices and quality metrics to change outcomes and reimbursements. Brownlee also suggested that providers needed to be viewed as competitively as insurance companies did to help solve this problem, and that the industry should be comparing the care physicians are providing in meaningful ways.Brownlee also advocated extending evidenced-based practices to patient care. “Most Americans think that whatever their physician has recommended is grounded in good science, and I think that at least half the time—if not more—it’s not grounded in any science, but belief, theory, or profit. In healthcare you can’t tell if something works unless you have good science.”Brownlee said that Americans need to change the current ethos of “more is better” to “less can be better.” She mentioned the
“Choosing Wisely” campaign as an important step in that direction. In that campaign, sponsored by the American Board of Internal Medicine (ABIM) Foundation, nine physician specialty societies identified the five specific tests or procedures that they say are commonly used but not always necessary in their respective fields.Bodaken recommended that the healthcare industry focus on the 1 percent of patients who account for 30 percent of healthcare costs. A move in that direction, he said, are 50,000 providers in Sacramento who took on the challenge of forming
accountable care organizations (ACOs) with shared risk to get costs down to zero.“The one challenge is devoting the amount of money that we’re going to have to devote to information technology to support automation, which is absolutely necessary, not only so providers can communicate to make sure they know what the evidence base is to provide care, but also so members and patients can look on a portal and see what the history of this physician doing this type of procedure is and how much it costs at hospital A versus hospital B,” he said. He said that this initiative would broaden to include 20 different ACOs over the next three years.“Those progressive physicians and hospitals will be more than happy to be paid on an outcomes basis because they in fact think they can make as much or more money,” said Bodaken. “They see it as a competitive advantage with those physicians who still want to be paid on a fee-for-service basis.”