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Report: U.S. Health Care Needs to Adopt Learning Culture



A new report by the Institute of Medicine (IOM), part of the National Academies of Science, says the U.S. health care system pays too much for outcomes that fall short on quality, but can learn from other industries to continuously improve the quality of care at lower cost. The committee that prepared the report for IOM was chaired by Mark Smith, president of the California HealthCare Foundation, with representatives from hospitals, pharmaceutical companies, insurance companies, medical schools, universities, and patient advocates.

The report highlights inefficiencies in the health care system that require a system-wide transformation to correct. The committee calculates that in 2009, about 30 percent of health care spending, estimated at $750 billion, was wasted on unnecessary services, excessive administrative costs, fraud, and other problems.  Moreover, inefficiencies cause needless suffering and endanger patients, with some estimates of tens of thousands of deaths that could be averted if systems worked properly.

“Our health care system lags in its ability to adapt, affordably meet patients’ needs, and consistently achieve better outcomes,” says Smith.  “But we have the know-how and technology to make substantial improvement on costs and quality.”

The committee says the problems have become so systemic that the time for incremental changes by individual providers has passed. The report calls for a system-wide transition to an an adaptive health care system “that learns, in real time and with new tools, how to better manage problems.” The full extent of current shortcomings in health care is visible, says the committee, when compared to the ways that other industries operate. For example, construction contractors use blueprints to coordinate the work of carpenters, electricians, and plumbers, and the auto industry produces thousands of basically standardized vehicles, which are customized at the margins.

The health care system now generates and captures an overwhelming amount of data, but better use of that data will be a key part of a continuously improving health system. The report calls for collecting data in digital formats to allow the data to become a better resource for managing the system, improving processes, strengthening public health, and generating knowledge.

The committee recommends more networking of databases and sharing of data to meet these goals. For example, payers and pharmaceutical or medical device companies could contribute more data to research groups to generate new insights. The report calls on regulators to clarify and improve rules governing the collection and use of clinical data to safeguard patient privacy, while promoting better care coordination and management, improved care, and enhanced knowledge. The committee recommends more patient involvement in medical decision making, with better tools for the delivery of clinical knowledge to patients, with portals established to share data among clinicians, patients, and families, with high-quality tools for shared decision making with patients.

The report cites the need for a change in payment models in health care that encourages the transition to a culture of learning. The prevailing fee-for-service model based on individual services and products, says the report, encourages waste and ineffective care. “Instead, payments should reward desired care outcomes and movement toward providing the best care at lower cost.” The report adds, “Payers should adopt outcome- and value-oriented payment models, contracting policies, and benefit design to reward and support high-quality, team-based care focused on patients’ needs.”

The transition to a learning culture will require cultural changes by the health care organizations throughout the system. The report calls for health care providers — including professional societies — and payers to increase the availability and transparency of information about the quality, price, and outcomes of care. In addition, health care delivery organizations need to develop organizational cultures that encourage continuous improvement, such as adoption of best practices and incentives that encourage teamwork and transparency.

The report was supported by the Robert Wood Johnson Foundation, the Blue Shield of California Foundation, and the Charina Endowment Fund.

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