Oct 09, 2014 10:00 AM

Author: Office of Public Affairs

Facing up to the momentous changes in health care can feel like the five stages of grief: Acceptance, denial, anger, bargaining and depression, and finally, acceptance and planning.

Unfortunately, about half the nation’s health institutions are stuck in the denial and anger phase, says Edward Clark, MD, chair of pediatrics at the University of Utah and Chief Medical Officer at Primary Children’s Hospital.

“They have not come to grips with the health care crisis in their communities,” Clark told attendees Tuesday at Utah Gov. Gary Herbert’s statewide Health Summit.

Straddling the state’s two largest health systems, Clark has a front row view of the forces disrupting health care and intimate knowledge of solutions being pioneering by Utah’s health industry.

“We have a chance to be a role model for the nation,” Clark said. Utah has a head start in the race for better, cheaper health care. No other state spends less per capita on health care and few register higher on the wellness meter, as evidenced by our consistently high ranking on national health scorecards.

But that doesn’t mean we can rest on our laurels, Clark said. “America’s health system has become too complex and too costly to continue business as usual…If we stand still we will be standing at the end of the line.”

If times are tough now, Clark paints an even grimmer scenario for 2025.

Utah’s population is booming and aging. Rates of chronic disease—obesity, diabetes, heart disease—are on the march. By 2025 most Americans will have insurance, placing more pressure on universities to educate tomorrow’s medical workforce.

Advances in medicine mean more people are living longer. By 2025 126,000 adults will be living with cancer and 700,000 will be in the early stages of heart failure.

The birth rate will have slowed, but more children will be living with costly, chronic health problems due to lifestyle, environmental insults and heroic medical efforts in the first few months of life. “We have chronically ill children who are becoming chronically ill adults. We are seeing a deteriorating health status among all our citizens,” Clark says.

Technology, historically a driver of health costs, advances at ever-increasing speeds. A tsunami of genetic information carries promise for more targeted treatments, but comes at a cost. Meanwhile federal research funding has declined more than 20 percent over five years when adjusted for inflation. Policy changes and consumer pressures are driving down health spending, and public and private payers are moving to blended payment models that will penalize providers for inefficient care.

“I am cautioning my colleagues that provider incomes will decline between 10 and 40 percent,” Clark says, noting it’s already happening in some fields.

But with adversity comes opportunity.

“We have three options as I see it. One is to ignore and die. The other is to accept and survive.  And the third is to embrace and thrive, which is what I believe we have the opportunity to do in Utah,” said Clark, pointing to successful efforts by the U. and Primary Children’s to cuts costs and improve care.  Among the examples:

  • Because the best way to reduce the cost of hospitalizations is to avoid hospitalization, Primary operates under a hub-and-spoke design, integrating community-based, primary care and hospital-based specialty care. Our hospitalization rate is the lowest in the country at 17.2 per 1,000 kids, compared to about 40 per 1,000 kids in the New England states, Clark said.
  • To care for the most medically fragile, costly children, Primary organizes “medical home” teams comprised of case managers, social workers, dieticians, nurses, doctors and others. The goal being to keep them healthy and out of the hospital. A study of more than 500 patients in these medical homes showed the model saved $4.2 million in annual medical costs.
  • Much of the health care in this country is duplicate and unnecessary. Using data to drive clinical decisions, faculty at University of Utah Health Care have reduced use of intravenous antibiotics—by 30 percent over a 45-month period.
  • Because U. faculty staff Primary, patients there benefit from the latest in research and medical advances. As states move to decriminalize cannabis, doctors at Primary Children’s are doing a trial of a pharmaceutical-grade cannabidiol product shown to have anti-seizure properties—adding scientific rigor to an emotional debate.
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