What are innovative ideas for healthcare to save money, increase efficiency and improve outcomes?

October 18, 2008 8:06 AM

What are innovative ideas for healthcare to save money, increase efficiency and improve outcomes?

What would be some ideas for changes to the existing US health system to save money and improve outcomes? For example, ways to better manage chronic disease, reduce medical errors, reduce duplicate tests, etc.

I'm interested in new ideas as well as ones that have been proven to work in other countries but could be "hacked" to fit the convoluted system we have here in the US.

posted by mintchip to health & fitness (14 answers total)

Checklists seem to be catching on. Apparently the Feds were against them at first, but they have reversed themselves.

When you read that New Yorker article, you will weep for how many lives have been lost for lack of a simple, obvious tool for so many years.
posted by kindall at 8:37 AM on October 18, 2008 [1 favorite]

Well, not to bring politics into it too much, but two things that would really help would be to (1) go single-payer, and (2) guarantee coverage to everyone. As stated in this detailed NY Books article, "The Health Care Crisis and What to Do About It":

The cost advantage of public health insurance appears to arise from two main sources. The first is lower administrative costs. Private insurers spend large sums fighting adverse selection, trying to identify and screen out high-cost customers. Systems such as Medicare, which covers every American sixty-five or older, or the Canadian single-payer system, which covers everyone, avoid these costs. In 2003 Medicare spent less than 2 percent of its resources on administration, while private insurance companies spent more than 13 percent.

At the same time, the fragmentation of a system that relies largely on private insurance leads both to administrative complexity because of differences in coverage among individuals and to what is, in effect, a zero-sum struggle between different players in the system, each trying to stick others with the bill. Many estimates suggest that the paperwork imposed on health care providers by the fragmentation of the US system costs several times as much as the direct costs borne by the insurers.

The whole thing is good, if you have time.
posted by rkent at 8:44 AM on October 18, 2008 [3 favorites]

Not an expert on the matter, but...
- Keeping people healthy in the first place (up-to-date nutritional education, regular and frequent exercise, training in self-care methods for stress) is probably the easiest way to reduce use of the health care system upfront. From what I understand, the US is going to see a huge drain on medical resources in the next few decades between obesity/diabetes and age-related injuries. Most US doctors, from my experience, cannot provide basic information on nutrition, physical activity, or non-pharma options for care. Ensuring that all doctors had a baseline facility with these areas would probably reduce costs.

- Having benefited from nationalized health care while living in other countries, it seems that inexpensive and easy access to a nurse or doctor allows people to address health issues before they become chronic or expensive to control.

- The specter of being denied coverage for a major condition (e.g., breast cancer or alzheimer's) simply because the condition shows up in your family history, drives many people to withhold information from their doctors (both genetic information and also symptomatic information). Eliminating this fear (and reality) would go a long way toward transparency in treating your health.

- Having your medical information follow you would probably lead to fewer errors in diagnosis, treatment, prescriptions, etc. I'm not a convert to GoogleHealth, though, by any means.

- Standardized information exchange from office to office, hospital to hospital. The variation in how bureaucracies acquire, label, file, and share information is staggering to me. If our health is going to be managed by numerous specialists at numerous offices, then they should at least be able to talk the same language and/or use the same forms to reduce the chances for error.
posted by cocoagirl at 8:45 AM on October 18, 2008

What are innovative ideas for healthcare to save money, increase efficiency and improve outcomes?

Remove all regulation and make it a completely free-market system. True competition would enable all of those. Of course, it would also severely limit access for people with low incomes, but you didn't ask about access.
posted by blue_beetle at 8:56 AM on October 18, 2008 [1 favorite]

Going digital and eliminating paper is supposed to cause a huge savings. Somewhere I heard 25%? I know, it's hard to believe but paper and printing and mailing all cost a lot. Plus the manhours of producing the documents. I think they do this in Taiwan. Since there are no penalties for pre-existing conditions people don't worry about having all their medical information on a smart card.

I learned about this from Frontline's Sick Around the World.

I'm all for no sweets or soda in schools and subsidized yogurt and whole grain bread (for starters) for those in poverty.
posted by cda at 9:36 AM on October 18, 2008

as a student I wholeheartedly endorse jogurt and whole grain bread.
posted by dunkadunc at 10:28 AM on October 18, 2008

moderate sin taxes on crap food, diverted to single payer preventative health care programs.

Coca Cola has a 60%+ markup -- $30B in sales on $10B of costs, so a 3% sin tax would collect a billion or so per year, that billion / $100/visit is 10 million free doctor visits.

We also need to increase the supply side -- break the guild nature of medicine so we have more trained medical professionals. Right now getting a medical degree is artificially limited such that once you have one you can command quite high wages. This is inefficient in gross and should be improved.
posted by troy at 10:51 AM on October 18, 2008

When I was in college we had access to student health services as part of attendance. They used one killer feature to separate non-serious common cold stuff from more serious symptomatics: the advice nurse. Call a number, talk to someone qualified to make basic diagnoses. It might sound crazy to diagnose something over the phone but I think in reality doctors use what you tell them more than physical examination to determine a lot of things. Based on my conversations with the nurse, it seemed she had a giant book in front of her with question series.

1) Do you have phlegm? yes/no
2) What color is it? clear/green/yellow
[flip to page 52 if green]
3) Are you experiencing nausea?
4) You have the flu. Stay in bed. Drink fluids. Call us in 2 days if symptoms worsen.

Perhaps this system worked for young people and their sniffles but would not be robust enough to handle a full-blown set of healthcare issues. But I've gotta say, the ability to call someone at ANY time and get informed advice on what to do was really great, and I'm sure headed off all kinds of piddly shit.

In a country where uninsured people with no regular doctor take their kids to the ER when they've got a fever, we definitely need some kind of remedial arbitrage and information service, as well as basic-level care clinics where you can get your blood pressure and temperature taken before you're escalated to a more serious care facility.

Just imagine how much it might lighten the load on hospitals and doctors to have an army of basic care providers out there in storefront clinics, taking care of the basic crap and escalating only the serious!
posted by scarabic at 10:56 AM on October 18, 2008

For a long time the hierarchy of care has basically been "see your GP, and if they can't fix it then see a specialist." There are so many complaints that can be handled perfectly well by nurses or by self care (after explanation by a nurse), I think the biggest way the industry is going to improve efficiency is by added practitioners at the low end of the escalation chain.

Many insurance companies these days have free nurse advice call lines similar to what scarabic described. It saves them a lot of money by preventing unnecessary doctor visits. And it's not like the nurse is really diagnosing, they've just got enough experience to know how high a fever needs to be to warrant an ER visit, or whether that cut needs antibiotics or more time given that it hasn't healed in 6 days, or whatever.

There's a big push in the healthcare industry right now to certify more nurse practitioners and physician's assistants, who are allowed to help people with general concerns (including prescribing medicine) without direct oversight by a doctor. The services of these nurses are typically less expensive than seeing a GP doctor, and in my experience they often have more time to spend with each patient than a doctor would. This leads to better care because the practitioner can take time to really understand what's going on with the patient, to avoid missing anything important.

The growth of retail clinics for things like strep tests and pink eye treatments are another great innovation that I think will continue to expand. On a similar vein, many clinics are now reserving some appointment slots each day for same-day appointments, so that people can get in to see their doctor quickly if something important crops up, rather than going to urgent care or waiting 2 weeks while their condition worsens.

As for dealing with chronic diseases, I think we're going to see more and more emphasis on nurse coordinators who help people manage their conditions. I've read about nurses whose job is to educate diabetes patients about how to take care of themselves, not just in a quick way like the doctor might do upon giving a diagnosis, but over the long term by calling regularly to make sure patients are watching their diets and taking care of their feet and scheduling appropriate follow-up appointments with doctors. This can help prevent complications, which of course saves money and improves outcomes.
posted by vytae at 11:47 AM on October 18, 2008

The triage process at incoming in a health care emergency / walk in facility is a proven method to ensure appropriate level of care and reaction time with minimum waste - for both the patient and the provider. Effectively, a qualified team do the initial triage and determine the care required, which may be follow up / prescription / clinic care with a nurse practitioner; intermediary that can be referred to a doctor on staff; or emergency/specialist care that requires a team or specialist response.

Funnily enough, checklists and single point admin are a vital part of this process to ensure its success.
posted by hannahkitty at 3:32 PM on October 18, 2008

My friend Dr. David Newman's excellent new book Hippocrates' Shadow makes the case that before and beyond universal coverage, a new honesty between doctors and patients could increase both wellness and efficiency by trusting patients to understand how many of the treatments and medications that they have been told are effective aren't really worth pursuing.
posted by nicwolff at 4:10 PM on October 18, 2008

Evidence Based Medicine.
posted by Violet Hour at 4:48 PM on October 18, 2008

The National Hand washing initiative of the Australian government is a great idea. Gone are gloves, and instead heath workers are using an alcohol based gel dispensed from a belt-attached hand pump. Infection control is one of the major areas of improvement in healthcare.
posted by mattoxic at 5:13 PM on October 18, 2008

I totally agree with rkent, about the multiple profit-making commercial entities attempting to (a) take their slice of the pie on the way, and (b) shift the costs of treatment onto one of the other players.
But I'd also like to add a need for economies of scale, both for for prescription drug purchasing and for medical treatment.
The UK National Health Service may suffer from underfunding (just like the US medicare system, successive governments have plundered surpluses of national insurance tax payments that were supposed to pay for future care, for other purposes). But one thing that the UK gets dead right is negotiating down the costs of pharmaceuticals. The UK national health service will not pay for brandname drugs when a generic is available. It also negotiates down the cost of brandname drugs because it buys the majority of them sold in the UK. Most drugs tend to cost a fraction of the cost that we are charged in the US. Decisions on whether to keep a drug prescription only are made on the basis of patient safety, not commercial advantage. Each British national only pays the equivalent of $15 co-pay for each prescription (waived if the individual is low-income or a senior citizen). No-one has to make the choice between the drugs that they need or food.
The other way that economies of scale come in is that national standards of treatment can be established, without the profit element coming in. There are well-established criteria for which treatments are covered in the UK system and which not, based on their medical prognosis. Thw downside is that you will wait longer for a non-life-threatening condition - people talk of an 18-month wait for a hip-replacement. But these economies of scale allow treatment to be free at the point of provision. You will not die of diabetes because you can't afford the treatment.
posted by Susurration at 6:33 PM on October 18, 2008