Delivering health care at the grassroots level and asking how it can be done better were the focus of a panel discussion Monday involving experts from across the country.
Participants of the discussion, which was organized by the American Enterprise Institute (AEI), were asked whether the Obama administration's attempt to lower costs and improve primary care delivery is working.
And the broad consensus among those participating was that some modest improvements have been made, but there are systematic issues that must be addressed before good services can be delivered at a lower cost.
The discussion, titled "The future of delivery system reform," was organized to get the views of those working at the coalface at the local and regional level rather than from the perspective of those based in Washington, D.C., moderator Joe Antos of AEI, told Patient Daily.
While government "has a gigantic impact," many people and organizations working independently of the center are successfully advocating for, promoting ideas about and delivering quality, and cost-effective health care, Antos said.
Panelists advocated greater involvement of physicians in management, real-time use of data, more transparency and a move away from the still-prevalent top-down approach to how services are delivered and how information is gathered.
One of the key reforms introduced under the Affordable Care Act that was aimed at delivering better, more cost-effective care at grassroots, or primary care, level was the creation and encouragement of accountable care organizations.
These groups of doctors, hospitals and other health care providers, who come together voluntarily to give coordinated high-quality care to Medicare patients, were to be rewarded for delivering high-value care.
But, as keynote speaker Dr. Brent James noted, deep inefficiencies remain. James is the recently retired head of the Utah-based based Institute for Healthcare Delivery Research, an arm of Intermountain Health Care, one of the providers in the region.
The issue of data and how it is used is a major issue, James said. Eighty percent of all information is not "truly computable," and many clinicians wait months for data to come back from the Centers for Medicare & Medicaid Services.
That means the information is "pretty much completely useless," and that most clinicians do not know "how their decisions link to the outcomes on a daily basis," he said.
Overall, James argued, financial incentives, when properly aligned and informed by quality data, can be leveraged to promote efficiency and improve clinical outcomes.
Others on the panel discussed other ways to improve the ACO model. Farzad Mostashari of Aledade, which operates 20 ACOs, talked about how to foster competition but still encourage collaboration
Speaker Elliott Fisher of the Dartmouth Institute for Health Policy and Clinical Practice said progress in establishing ACOs as they were meant to operate has been sluggish.
Jeff Selberg of the Peterson Center on Healthcare described how his organization attempted a pilot program to deliver the best care at the best price to match the top 4 percent to 5 percent of primary care practitioners in the country.
The organization managed it, Selberg said, but it took a long time and a too high a cost to replicate across all its centers.
AEI’s James Capretta noted any delivery reform without fundamental changes to how Medicare itself is managed.
Moderator Antos, in an interview prior to the panel discussion, said he does not believe ACOs' implementation has stalled.
"There is always a certain amount of momentum that stays with government programs no matter if there is a change of government," he said. "The ACOs will continue; they are not going to be stopped."
