A recent MinnPost article by Susan Perry shared excerpts from an article by Shannon Brownlee from the Lown Institute. In “Over-treated: Why Too Much Medicine Is Making Us Sicker and Poorer,” Brownlee delivered three main points: 1) only a few “lone ranger” doctors are working against a powerful medical complex that keeps delivering treatments patients don’t need; 2) these doctors can’t “buck” this aspect of modern medicine because of factors such as pharmaceutical marketing, fear of lawsuits, misguided patients, and lack of knowledge about medical evidence; and 3) reducing medical overtreatment will require large-scale political mobilization.
We applaud Brownlee for shining a light on the fact that many of our nation’s health-care systems have for too long overdiagnosed and overtreated patients, contributing to inappropriate care and waste we cannot afford. We as a nation — both the health-care system and citizens — have the flawed belief that more care is always better care, and that more expensive care provides even better care.
However, we disagree with the conclusions that only lone rangers are working on this issue and are unable to change the system. Minnesota is leading the movement to reduce overtreatment and make care more affordable.
No lone-ranger effort
The Institute for Clinical Systems Improvement (ICSI), a nonprofit health-care-improvement organization, and MN Community Measurement (MNCM), a nonprofit health-care measurement organization that publicly reports cost, quality and patient experience results, have been working with medical groups, hospitals and nonprofit health plans in Minnesota to deliver high-quality, appropriate care for years. This is not a lone-ranger effort; ICSI is composed of more than 50 medical groups representing 8,000 doctors, and MNCM reports on more than 300 medical groups, 1,600 clinics and 140 hospitals.
Through collaborative efforts, medical groups, health plans, patients and other stakeholders are focused on achieving the triple aim of better care, better health and lower costs. Some recent examples include:
- Medical groups and health plans collaborated to embed evidence-based criteria into electronic health record systems to ensure appropriate diagnostic imaging scans were ordered. This saved an estimated $234 million, prevented an estimated 100 cancers from unnecessary X-rays and improved patient experience.
- The RARE (Reducing Avoidable Readmissions Effectively) Campaign, led by ICSI, the Minnesota Hospital Association and Stratis Health, engaged 86 hospitals and 104 community partners to prevent 7,975 avoidable hospital readmissions. This saved an estimated $110 million and allowed Minnesotans to spend an estimated 31,900 more nights sleeping in their beds rather than in hospitals.
- MNCM recently released the nation’s first publicly reported, statewide Total Cost of Care results for medical groups. By gathering all costs for treating patients — professional, inpatient, outpatient, pharmacy, lab, radiology and more — into an average monthly patient cost, consumers can now for the first time compare costs of care across 115 Minnesota medical groups, representing 1,052 clinics. Medical groups are using the information to evaluate how to provide more high-quality, cost-effective care.
- ICSI, the Minnesota Medical Association, and the Minnesota Health Action Group are raising awareness statewide of the national Choosing Wisely campaign, which seeks to foster meaningful conversations between doctors and patients on care that is appropriate.
We agree wholeheartedly with Brownlee’s call to reduce medical overtreatment. Current health-care costs are unsustainable, especially since the health-care system alone only contributes to 20 percent of the population’s health. If we are overspending on health care, we take money away from education, employment and the environment — other factors that contribute more to our population’s health than doctors and clinics.
We also agree a large-scale mobilization is needed to reduce medical overtreatment. But it doesn’t have to be solely political — the work locally proves it.
New products, systems and efforts
We all have to mobilize — the health-care industry, our communities, and we as individuals. Politically this is being recognized through federally funded initiatives to develop and test health-care payment and care delivery models that will improve performance, increase the quality of care and decrease costs. Minnesota nonprofit health plans are designing new insurance products and payment systems that reward value, not just volume. Mobilization is also being encouraged through grant-funded efforts. ICSI is leading the Robert Wood Johnson Foundation (RWJF) funded initiative “Going Beyond Clinical Walls” to help bring clinicians together with community leaders and resources to provide better care and lower costs; a MNCM-led, RWJF-funded effort is helping consumers better understand and access information on the quality of healthcare provided by local physicians.
A better health-care system can emerge from existing strategies. We’re doing it here through strong community and health-care partnerships, and the willingness of diverse stakeholders to tackle complex issues that no entity can solve alone. There is still considerable work to be done, but Minnesota is a leader.
Sanne Magnan, M.D., Ph.D., is the president and CEO of the Institute for Clinical Systems Improvement. Jim Chase, M.H.A., is the president of MN Community Measurement. Learn more at ICSI.org and MNCM.org.
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