Health Care Insider: Why American Health Care Can’t Seem to Control CostsJun 9, 2014
Health care is expensive and costs continue to rise. Part of the problem is we’ve become really good at innovating diagnostics and treatments at the cost of not innovating new models of delivery needed to control costs. Chris Trimble, an expert at helping organizations innovate and co-author of “How Stella Saved the Farm,” talks about why changing the system is proving to be so difficult.
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Interviewer: I think most people would agree that health care is too expensive. I mean we all pay insurance premiums. Chris Trimble is an expert on making innovation happen in large organizations. I wanted to talk to him a little bit about what he thinks the reason for that is. Why are things so expensive in health care?
Chris Trimble: The reason things are so expensive in health care is we've all lived through an era of medical miracles. Think about where we were 20, 40, 60 years ago in medicine. We've had enormous successes in advancing the science of medicine and the technology of medicine, and we have new diagnostics and new therapies that were unthinkable not that long ago. All of this costs money. What we need to be more and more cognizant of is that some of these new technologies their benefits aren't so huge anymore.
Chris Trimble: We need to be a little bit more aware that everything has a cost and a benefit to the patients, and we shouldn't expect as patients that no matter what ails us doctors will have a solution.
Interviewer: Yeah. So, maybe a $10,000 treatment will be just as effective as the brand new shiny $100,000 treatment is the case.
Chris Trimble: Exactly right. We need to shift more of our attention in health care from innovation that comes in the form of new diagnostics and new therapies to new models of health care delivery that increase value, increase outcomes, increase quality while reducing costs. You can't walk a hundred yards in healthcare without running into two, or three, or five, or ten good ideas for doing exactly that.
Interviewer: Sure. It sounds like health care is like the guy at the gym that does a lot of bench presses but his legs are suffering. It sounds like health care's legs are suffering and they need to build those up a little bit maybe.
Chris Trimble: We have been so passionate about innovation in the form of new diagnostics and new therapies, and that's led us to overlook all kinds of opportunities to make health care more effective by changing the delivery model.
Interviewer: To me it doesn't sound like that different of a problem really. Like, innovation is innovation whether it's making a new widget, or coming up with new technology, or if it's figuring out a way to make it less expensive. What are the barriers?
Chris Trimble: We have a system in the United States in particular that is perfectly aligned for innovation in the biosciences. If you're an inventor and you've got a new device or a new drug you've got a whole industrial complex that's well established and nicely set up to help you bring that new technology to market. If, on the other hand, you have in mind a new model of primary care that is interested in taking patients who are quite ill with one or more chronic diseases and keeping them healthy enough to stay out of the emergency room and out of the hospital, that's quite in conflict to the system we have, and it's much harder to move that kind of innovation forward these days.
Interviewer: Yeah, and that kind of innovation has to bust trail, so to speak, because the inroads, the infrastructure is not there to get that innovation where it needs to go.
Chris Trimble: Yeah, that's exactly right. You've got to blaze new trail, and it sets up a pretty high degree of difficulty management challenge where organizations are trying to both build new types of care and simultaneously sustain excellence in the business that they're already in and that pays the bills.
Interviewer: Yeah. What kind of innovations have you seen? Because I know you travel to a lot of different hospitals and you help them try to solve this problem. What are you excited about?
Chris Trimble: Yeah. I'm excited about first and foremost where I go and find new forms of teams being created. We are accustomed to and historically have been locked into a model where the physician is at the top of the pecking order and everybody is there to support a fairly autonomous fairly independent physician. There has been a place for that, and that's been an important model. I'm certainly not the first to observe that we're moving into an age where more teamwork is needed. Where I think I can add energy to the discussion here is we need to get way more creative about thinking about what form those teams might take. Some of the most important teamwork I'm seeing done in health care these days doesn't look like traditional health care at all. Doctors are in supervisory roles or are called upon only when their specialized expertise is needed.
Interviewer: Yeah. They used to be hands on.
Chris Trimble: All the time.
Interviewer: Now supervisory. Okay, keep going.
Chris Trimble: That's right. Some new roles and responsibilities are proving very important. One in particular is health coaches that in one clinic I looked at are proving enormously effective in keeping low income adults with multiple chronic diseases healthy enough, as I said earlier, to stay out of the hospital, out of the emergency room.
Interviewer: Yeah. Just with a health coach which costs a lot less in terms of training and how much would have to be spent on that person.
Chris Trimble: It may look like it's more expensive at first. You may spend on a team of health coaches a lot more money than you would on a traditionally staffed primary care office, but if the payoff is no emergency room visits and no hospitalizations that's better for the patient and it's better for the system.
Interviewer: Is this kind of change going to happen overnight?
Chris Trimble: Well, it can be dramatically accelerated if we continue to see payment reform. It's the most important thing happening in health care right now. We've got to get away from the fee for service model, which rewards exactly the wrong kinds of behaviors, and move towards models that are capitated where providers have the incentive to keep people healthy not only treat them when they're ill.
Interviewer: Just to clarify, if I understand correctly pay for service means every time I go in, even if I go back in because of a complication, I'm paying money, the hospital's getting money.
Chris Trimble: That's right.
Interviewer: The other model is you get X amount of dollars to keep this person healthy. Is that correct?
Chris Trimble: That's exactly right.
Interviewer: That's going to really change things as you see it.
Chris Trimble: Everywhere I go I see lots of small examples of good innovations in health care delivery that remain small because the payment system is in the way. If we change the payment system those good innovations will start to grow and we'll all be better off as a result.
Interviewer: So the time is now.
Chris Trimble: The time is right now.
Interviewer: The time is right now. Any final thoughts for our listeners that might be a little discouraged by their high insurance premiums as they stand?
Chris Trimble: I think you want to engage as a patient in health care in a different way in the future than you have in the past. You want to change your expectations. If I had to put it very briefly I would want more patients realizing that more care is not always better care. Sometimes the better outcome for you means fewer visits to the hospital, fewer procedures, more healthy time with your family at home.
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