May 24, 2010
When I first came to Michigan from Indiana a year ago, I knew I was coming to a special state for health care.
Impressively, hospitals across Michigan have topped the national charts for years when it comes to providing high-quality health care. And compared with most states, Michigan has a long history of innovative pharmaceutical and medical research, excellent private insurance coverage for workers and a strong medical safety net for the poor.
Now, as we face known and unknown implications of federal health care reform, an increasingly competitive statewide environment and ongoing economic challenges, we also stand at an important fork in the road, where the path we choose will determine the future of our health care institutions, as well as the health of our citizens and of our broader state economy.
One direction will take us down an open road, wide enough for healthy industry competition to co-exist with collaboration and partnerships that leverage the extraordinary knowledge and expertise of Michigan’s health care community. This direction has the potential to lead to cost containment while preserving our ability to serve Michiganders with the excellent care they deserve.
Another direction could force our hospitals and other providers down a road toward intense competition that would move us away from why most of us entered health care in the first place – to discover and implement the science and practices that make people and communities healthier. That path could also compromise our ability to reinvent and reinvigorate Michigan.
In many important ways, we’ve already started down the open road.
Hospitals and doctors’ groups across the state are working together to improve the efficiency, quality and safety of the care they provide, while containing the growth of health care costs. In addition, they are finding ways to make sure patients have access to as much care as possible closer to home so they only need to travel to receive the most specialized care.
For instance, dozens of hospitals across the state have united in the shared interest of improving the care of patients with clogged arteries through the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. By sharing data and best practices – together – we’ve prevented needless complications in thousands of patients and saved millions of dollars. We’re engaged in the same type of statewide collaborative work with initiatives that focus on everything from stroke to cancer to surgery.
Similar collaborations and sharing of best practices are happening in doctors’ offices statewide. Thousands of physicians are taking part in the Physician Group Incentive Program, a cooperative effort to improve the quality of the care they provide through their group practices. One example of the power of these partnerships is the savings of $29 million realized through specific steps to increase the use of generic drugs.
In support of this effort, University of Michigan teams have been training participating physicians in the “lean thinking” approach that many industries have used to streamline their manufacturing processes. We’re using a “lean” approach at the U-M Health System with great results and are excited to share this methodology with our partners across the state so that they can implement systematic changes that benefit their practices and organization.
We have to work hard to stay on a course of partnerships and overall improvement of health care delivery in Michigan. We cannot lose site of the benefits of collaboration and cooperation, especially as the forces of health care shift and especially as our citizens continue to need and deserve the best care.
Hospitals, health systems and physician groups have a choice to make about which path we take. Let’s make the right one.
Ora Hirsch Pescovitz, M.D., is the Executive Vice President for Medical Affairs at the University of Michigan and CEO of the U-M Health System.
Dr. Pescovitz correctly frames the two paths which health care in Michigan might take. Unfortunately, despite nominal efforts being made toward collaboration, the overwhelming preponderance of evidence indicates that intense competition will be the road actually traveled. One only has to turn on the television, look at the billboards, gaze at the health care facilities being built or marvel at the establishment of all the new medical schools to realize that competition, not collaboration, will be the order of the day. There are at least seven major health systems in Michigan all now vying for the "gold medal" of health care in Michigan (i.e. "come or refer to us because we have the best doctors, the most modern buildings and the most advanced technology!!!"). Given the economic conditions of the State and the ongoing "out migration" of its citizens, the State can probably only support three, or perhaps four, at most. The waste, fragmentation, inefficiency and duplication of this "medical arms race" ultimately contributes to confusion, suboptimal quality and escalating costs. Collaboration appears to be like acetaminophen , it reduces pain and makes you feel better. Competition however, appears to be more like morphine, in addition to really reducing the pain and really making you feel better, it is addicting and we all know how hard that is to overcome.
Posted by Douglas R. Woll, M.D., 05/25/2010 (4 months ago)
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