The Case for Quality in Health Care (Monday December 28, 2009 @ 4:10PM)

By Dr. James Kerby for Business Review

The debate over health care reform has dominated the news at both the national and local levels in recent months. What is agreed by nearly everyone is that our present system is broken and unsustainable for the future. Costs for health care continue to increase at an exponential rate, while the population of those unable to access care continues to expand.

Last month, U.S. News & World Report and the National Committee for Quality Assurance released the 2009-2010 rankings of Best Health Plans, which highlight those providers who consistently deliver high-quality health care to their patients. In the midst of the struggles facing our nation and community, is a conversation about the quality of health care even relevant?

I would suggest that it is critical, and impacts every other aspect of the debate.

It’s difficult to fix a problem if we aren’t clear about what the solution looks like. For many of us, the health care system is pretty simple, and works just fine. We have insurance, and maybe see our doctor once a year, unless we get sick. If something serious happens, we go to the hospital. This experience is disconnected from the mind-numbing complexity that is the national health care debate.

Politicians and the media further complicate matters with buzzwords and sound bites designed to support their position, but add little clarity to the discussion.

The concept of quality, on the other hand, is something we all can understand. When making a purchase decision, we assign value to the product based on the features and benefits that are most important to us. By examining the health care debate through this lens, a picture of what the system should look like begins to come into focus.

So how do we define health care quality? I would suggest the following characteristics as a starting point:

• Evidence-Based Medicine.

Cost is the biggest factor driving the need for health care reform. Evidence-based medicine is like a road map that, combined with the doctor’s experience, leads to treatment that produces a favorable outcome, while eliminating unnecessary expenses. Currently, less than half of patients in the U.S. receive recommended evidence-based treatments. As a result, many prescribed treatments are either unnecessary or ineffective. This waste adds an estimated $250 billion to $325 billion to America’s health care bill every year.

• Doctor/Patient Relationship.

No amount of scientific research can replace the insight that a doctor gains from knowing their patients on a personal level. Research confirms that a positive relationship, where doctor and patient work together to solve health problems, produces greater satisfaction and improved response to treatment.

While not a guaranteed cure, it can go a long way toward providing peace of mind.

• Impartial Third-Party Oversight.

Having an unbiased third-party monitoring practice standards is key to ensuring high quality care. The National Committee for Quality Assurance oversees primary health care providers. The NCQA is a private, not-for-profit organization dedicated to improving health care quality, and has been a central figure in driving quality improvement throughout the health care system nationwide.

These characteristics help bring understanding to the issues impacting the health care debate, from a perspective that is balanced and in the proper context.

On a personal and local level, understanding what quality looks like provides a basis for evaluating our own care.

James Kerby is vice president of medical affairs at Grand Valley Health Plan in Grand Rapids. Grand Valley Health Plan was just ranked among the top five commercial health plans in the nation, for the second consecutive year, by U.S. News & World Report and the NCQA.