With the U.S. Supreme Court hearing arguments this week over the future of the Affordable Care Act, the 60-plus people attending the St. Norbert College CEO Breakfast Series on Wednesday in Appleton were waiting to hear what Dr. John Toussaint, CEO of the ThedaCare Center for Healthcare Value, had to say.
“I have no idea what the Court will decide, but I do know that whatever they decide it’s not going to fix the problem we have in this country that healthcare costs too much,” says Toussaint, who is also CEO emeritus of ThedaCare, an Appleton-based healthcare system and a national speaker and author on healthcare improvement, payment reform and transparency. “We have to make some fundamental changes to fix what’s wrong.”
And what’s wrong is that healthcare spending continues to go up. In 2011, 18 percent of the nation’s GDP was spent on healthcare. That’s up 2 percentage points from the year before. “We need to do something or we’re going to bankrupt ourselves,” Toussaint says. “Costs are out of control.”
The best way to control costs is to reform the system, drive out waste and bring more overall transparency to the market, Toussaint says. “What we have right now is a dysfunctional system,” he said.
That dysfunctional system is growing the ThedaCare Center for Healthcare Value. When it began a few years ago, there were just two employees in two offices. Today, there are 15 employees taking up a good portion of the third floor in the Appleton Center.
One of the key ways to fix the system is putting patients at the center is the first critical step and breaking down the barriers between different providers and departments. The next step is to share information with consumers about costs and outcomes, Toussaint said. Two organizations in place – Wisconsin Health Information Organization and the Wisconsin Collaborative for Healthcare Quality – are doing that now in Wisconsin, but many consumers don’t know about the sites.
“There’s such a wide range of costs out there in the state. Our data shows the cost of a knee replacement could be as low as $17,000 or as much as $55,000 depending on where you go. Consumers need to know that and start asking questions,” he says.
Another way to repair the healthcare system is change how providers are paid, Toussaint says. Some organizations are experimenting with different options, such as bundle payments (where there is one cost for an entire procedure from beginning to end) and rewarding doctors for providing a higher quality of care.
“For example, if last year it cost X amount to treat 20 patients with diabetes and this year you are able to treat those same 20 patients for less, you earn a bonus. And all of this is done with improving care and outcomes,” Toussaint says. “There are a lot of pilots out there to test new ways for how to pay for healthcare. No one knows the answers yet. We just have to keep experimenting to see what will work best.”
To learn more about the ThedaCare Center for Healthcare Value and see links to the WHIO and WCHQ, visit www.createvalue.org.
by MaryBeth Matzek