Quality and Costs: A
Twisted
Relationship
Costs are and have been increasing at
an UNSUSTANABLE rate
L. Gregory Pawlson MD, MPH, FACP
Executive Vice President NCQA
Long Term Health Cost Trends
100
90
80
70
60
50
40
30
20
10
0
00
50
Quality is not so great either!
21
20
00
25
20
19
50
Healthcare
GDP
20
GDP
%
Healthcare Costs as a PERCENTAGE of
GDP
Growing Evidence that Value of Health
Care is Far from Optimal
Growing Evidence that Value of Health
Care is Far from Optimal
• The “old” RAND study- lack of relationship
between volume and appropriateness (Brook et
al)
• Documentation of wide variation in rates of use of
treatments and lack of relationship between
quality and quantity of services (Wennberg et al)
• Patient safety studies-up to 100,000 hospital
deaths due to errors and avoidable complications
(Brennan, IOM)
• Over 25,000 deaths avoided each year if under
treatment level raised to achievable benchmarks
(90% tile of highest performing health plans)
(Eddy-Archimedes, NCQA State of Health Care)
• Evidence from current measurement: less than
50% of diabetes, hypertension or asthma treated
optimally with existing medications (McGlynn et
al)
1
Summary of Findings
• There are substantial opportunities for
improved care
• Appropriateness and volume of services
do not appear to be closely related
• Rate of increase of costs IS a problem that
should concern everyone
• Quality and the quantity of services and
cost of care provided do not appear to
have simple direct relationship (? Inverse
at this point)
What should a “value based”
Health Care Do?
Current Health Care
Spending
A: Move people from
“Right to Left” —and
keep them there
Ideal
Spending
Healthy/
Low Risk
AtRisk
High
Risk
Severe
Early
Symptoms Disease
20% of people
generate
80% of costs
A value-based health care system
Source: HealthPartners
Challenge: What do we know about the
relationship of cost and quality-and
what can we do to optimize value?
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