NEJM Catalyst
Namita Seth Mohta, MD, Edward Prewitt, MPP, Lisa Gordon, and Thomas H. Lee, MD, MSc
April 20, 2022
The ratio of spending to GDP in the OECD developed countries jumped from 8.8% in 2019 to 9.7% in 2020.
Health care spending grows.
The Covid-19 pandemic turbocharged care delivery in many countries; the ratio of spending to GDP in the OECD developed countries jumped from 8.8% in 2019 to 9.7% in 2020.
But health care expenditures have been growing steadily for decades, a trend that is expected to continue for decades.
“Bending the cost curve” slightly downward, rather than actually decreasing spending, is considered success.
Health care spending grows. The Covid-19 pandemic turbocharged care delivery in many countries; the ratio of spending to GDP in the OECD developed countries jumped from 8.8% in 2019 to 9.7% in 2020.
What if health systems could reverse this current, rather than considering it inevitable as the tides?
An article in this issue of NEJM Catalyst Innovations in Care Delivery, “Low-Value Care De-implementation: Practices for Systemwide Reduction” by Corinna Sorenson, PhD, MHSA, MPH, of Duke-Margolis Center for Health Policy and colleagues, shows how a handful of leaders have eliminated wasteful or harmful health care services, which have been estimated at $100 billion annually in the United States alone.
The authors offer a framework for readers to use in identifying and rooting out such spending.
The Insights Report in this issue reflects on a survey of how health care professionals worldwide pay for care delivery.
“Payers and Providers Seek Value-Based Care, but Progress Is Slow,” with William Shrank, MD, MSHS, and Brian Powers, MD, MBA, of Humana, finds a widespread desire for value-based payment but little progress over the last few years, and scant alignment between payers and providers.
In the related Insights Interview, three Insights Council members discuss how to make progress with value-based care.
The other articles and case studies here also address value — how to do more with less, how to do better for cheaper, and how to improve care for patients and clinicians alike.
“Treating Hepatitis C in a Substance Use Recovery Program: A Limited-Resource Group Model” by Quinnette B. Jones, MSW, LCSW, MHS, PA-C, of Duke University School of Medicine and colleagues is a case study of a treatment center with a tight budget using cost-effective group treatment to extend important care to its patients.
“Targeted Management of Excess Specialty Spending: The Case of Biologics for Retinal Disease” by Helena Moon, MD, and associates at CommonSpirit Health — the second-largest nonprofit health system in the United States — makes the case for a less expensive drug but also acknowledges the difficulty of obtaining buy-in even among the system’s own clinicians.
Two pieces in this issue examine the use of technology to improve care delivery.
In “Closing the Care Gap for People with Severe and Persistent Mental Illness: Collaborative Care, Telehealth, and Clinical Pharmacy,” Esti Iturralde, PhD, of Kaiser Permanente Northern California and colleagues present a telehealth program that allows advanced practice clinical pharmacists to engage with patients. “A New Technology-Enabled Care Model for Pediatric Type 1 Diabetes” by David Scheinker, PhD, and colleagues at Stanford University and the Lucile Salter Packard Children’s Hospital Stanford profiles the use of wearable sensors and telemedicine to improve access, equity, outcomes, and the provider experience.
Look to every issue of NEJM Catalyst Innovations in Care Delivery for similar accounts of how health care can be made more effective, efficient, and even less expensive. We welcome your article submissions on the full range of care delivery topics through our Author Center.
Namita Seth Mohta, MD
Executive Editor, NEJM Catalyst; Director, Serious Illness Care Program, Ariadne Labs, Brigham and Women’s Hospital, Boston, Massachusetts, USA; Faculty, Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Assistant Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA
Edward Prewitt, MPP
Editor-in-Chief, NEJM Catalyst Innovations in Care Delivery; Co-Chair, NEJM Catalyst Editorial Board; Chief Medical Officer, Press Ganey Associates, Inc., Boston, Massachusetts, USA; Member, Editorial Board, New England Journal of Medicine
Originally published at https://catalyst.nejm.org on April 20, 2022.
Names mentioned
William Shrank, MD, MSHS, and
Brian Powers, MD, MBA, of Humana
Esti Iturralde, PhD, of Kaiser Permanente Northern California
