Amy Klobuchar: Health care lessons from Minnesota

  • Article by: AMY KLOBUCHAR
  • Updated: June 17, 2009 - 6:49 PM

A coordinated and integrated system can save billions of dollars each year.

It seems as if Americans have waited for more affordable health care for about as long as Minnesotans have waited for the Vikings to win the Super Bowl. At least with the Vikings, we can always plead, "Just wait until next year." With health care reform, however, our time is up and we can't afford to wait any longer.

As we prepare to take up landmark health care reform legislation, many in Washington are looking to Minnesota as a leader. Among them is President Obama.

In a recent weekly radio address, the president highlighted how the Mayo Clinic and other innovative health care organizations succeed in providing high-quality care at relatively low cost.

"We should learn from their successes and promote the best practices, not the most expensive ones," he said.

In our state, the Mayo Clinic isn't alone. Many providers are among those already working to deliver the best care at the best price, and with 92 percent of the state covered by some form of health care insurance, Minnesota has a strong history of making sure that our health care system promotes both quality care and access.

The importance of Minnesota's best practices to national health care reform can be distilled into a game plan with a few key pointers:

First, be sure to keep score. That means measuring outcomes and rewarding providers who deliver quality results. Right now, in many places, we're not getting our money's worth from our health care dollars.

In Miami, Medicare spends twice as much on the average patient as it does in Minneapolis, even though quality is much better here. According to researchers at Dartmouth Medical School, nearly $700 billion per year is wasted on unnecessary or ineffective health care. That's 30 percent of total health care spending.

It's no surprise. Most health care is purchased on a fee-for-service basis, so more tests and more surgeries mean more money. Quantity, not quality, pays.

At a place like the St. Mary's in Duluth or in the groundbreaking work of HealthPartners with diabetes, the priority is value, not volume. In fact, if the spending per patient with chronic diseases everywhere in the country mirrored the efficient level of spending in the Mayo Clinic in Rochester, Medicare could save $50 billion over five years.

To begin reining in costs, we must have all health care providers aiming for high-quality, cost-effective results. That's why I've introduced legislation in the Senate that would create a "value index" as part of the formula used to determine Medicare's fee schedule. It would give physicians a financial incentive to maximize the quality and value of their services instead of the volume, something we do so well in our state.

Second, it's all about teamwork. Understandably, patients like it when their health care providers talk with one another and even work together. It means higher-quality care as well as more efficient care.

In too many places, however, patients must struggle against a fragmented delivery system where providers duplicate services and sometimes work at cross-purposes.

The beauty of integrated care systems is that a patient's overall care is managed by a primary care physician in coordination with specialists, nurses and other care providers, as needed. It's one-stop shopping. In our rural communities, Critical Access Hospitals use this model and provide quality health care for residents in their communities with a team of providers.

Studies show that moving toward a better integrated and coordinated delivery system could save Medicare alone up to $100 billion per year.

Finally, the best offense is a good defense. It's a lot better for both the patient and the pocketbook if a chronic medical problem can be prevented or managed early to stave off complications and the need for costly care.

Right now, physicians are paid to treat diseases, not prevent them. Yet a payment system that encourages prevention and disease management could generate enormous savings, because a large portion of health care spending is devoted to treating a relatively small number of people with chronic medical conditions.

The Minnesota playbook provides a winning formula for health care reform. We can improve our system to expand what works and fix what is broken, so Minnesotans can continue to enjoy the high-quality, low-cost care we have today and the rest of the nation can enjoy Minnesota quality health care.

Amy Klobuchar, a Democrat, represents Minnesota in the U.S. Senate.

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