McClellan: Healthcare system shifting to prevention

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Mark B. McClellan, MD, PhD, former administrator of the Centers for Medicare and Medicaid Services (CMS) and former commissioner of the U.S. Food and Drug Administration, delivered the closing keynote address at the 2007 Frontiers of Health Care Conference held at Brown University in Providence, R.I., yesterday.

McClellan described genomics as a tool to help deliver the best possible medicine. “The goal is getting the right treatment to the right patient,” he said. He cited the improvements made over the last several decades in improving the length and quality of life for most Americans and said that “the potential is even greater, that in the 21st century we can put past progress to shame. You’d think main feeling would be optimism but it’s not. It’s frustration and anger.”

Because the U.S. healthcare system does a poor job of prevention, 45 percent of healthcare spending goes toward chronic conditions. The rise in obesity—from 17 percent of the population to 33 percent since 1990—makes healthcare costs 20 percent higher, McClellan said.

A shift toward more preventive care has begun, however, he said. While healthcare reform traditionally focused on covering more of the uninsured, the goal is moving toward delivering high value care. McClellan said that both Sens. Hillary Clinton and Barack Obama have been discussing the topic on the campaign trail. They are talking about more effective use of information technology and other ways to deliver more value, not just cover more people. “We’re going to see a lot of debate,” McClellan said. “No matter who controls the White House or Congress in 2009, they’ll be looking for ways to cut healthcare costs.”

The current system does not encourage preventive care, however. McClellan cited a program at Duke University Medical Center which implemented a variety of tactics, such as better health information technology and even alternative medicine, to improve healthcare quality. They experienced fewer patient visits, fewer lab tests and imaging procedures, increased patient satisfaction and lower costs to Medicare and other third-party payers. But, revenue went down. “They didn’t get paid to keep patients healthy,” McClellan pointed out. “It’s a challenge to get these types of programs going. Our revenue system doesn’t promote this. The pay is the same regardless of results.”

After successfully implementing several quality reporting initiatives for hospitals, Medicare will begin measuring outcomes through patient satisfaction rates, complication rates and more. That will help “break down the silos of quality,” he said.

“The opportunities are tremendous,” McClellan said. “We will get to better care and more value for our money.”