Whatever anyone thinks about the federal health care reform law, this is undeniably a period when the health care industry is undergoing massive changes. Much of that change is welcome.
While the health reform law is driving many of those changes, more than a little is the result of raw economic forces that are, independent of the law, pushing one of the developed world's least-efficient health care systems toward wiser use of limited resources.
Most recent of those developments locally is Independent Health's just-announced program aimed at cutting out unnecessary costs in health care and using the savings to lower premiums on one hand and to better reward primary care physicians on the other: better care for less money.
"In industry, they say 'Do it right the first time,' " said Dr. Michael W. Cropp, president and CEO of Independent Health. Otherwise, costs balloon. That's the theory behind this effort, he said. "Better quality costs less."
The project, called the Primary Connection, includes 140 physicians associated with Independent Health. It has several components, but chief among them is better coordination of care, teamwork, greater use of data to track quality and costs, and payment arrangements that reward physicians for the quality of care they deliver, not just the amount of care. Leading the effort to better coordinate care in this program are primary care physicians.
While primary care physicians - family doctors, internists, pediatricians and geriatricians - are usually the first place patients turn for care, they are paid significantly less than specialists even as their office costs rise and greater amounts of their time are devoted to non-revenue producing tasks.
Primary Connection is designed - cleverly, it seems - to answer that problem in a way that not only improves care and better rewards the doctors, but also deals with a troubling decline in the number of primary care physicians. This is an urgent matter, especially as the health care reform law takes effect, providing coverage to the uninsured. Without an increase in the number of caregivers, the system will be overwhelmed.
Of course, it's not just doctors who deliver quality health care, but also nurse practitioners and physician assistants. Primary Connection seeks to better incorporate their roles into the team approach it envisions, in which the primary care physician acts as quarterback to all those delivering care, including specialists. In return, Cropp said, primary care physicians could see their incomes double, even as premiums decline, based on the elimination of wastefulness within the system.
That the U.S. system of health care is wasteful is beyond dispute. Health care consumes a larger share of gross domestic product in this country than in any other industrialized nation while producing results that are generally mediocre. Without reforms, it is all but certain to collapse.
Independent Health's new contribution to this cause is welcome and, while it is starting small, it is liable to have a healthy radiating effect: Doctors who adopt the system cannot, as a practical matter, limit its application to patients covered by Independent Health. The benefits will spread.
Other insurers are also seeking to improve quality. Earlier this year, BlueCross BlueShield of Western New York partnered with Kaleida Health and a group of physicians to eliminate unnecessary procedures and decrease paperwork. Its backers say the effort will free staff to better manage the care of patients with chronic conditions. Univera, meanwhile, is using a carrot-and-stick approach that rewards clients for healthy lifestyle choices.
These are all hopeful developments. Americans cannot withstand the continued spiral of health care costs, and everyone - insurers, providers, patients and, yes, the government - has an important role to play. Independent Health appears to be making a solid contribution to that effort.