He has a simple three-point plan to heal our ailing health care system:
Eliminate fee for service: His first priority is to change the way we pay for care, which currently encourages doctors and hospitals to order as many tests and procedures as Medicare and other insurers will allow. A 2009 report from the Institute of Medicine estimates that 30% of all spending on health care is squandered. Apply that to the $2.7 trillion we spent last year, and you get $810 billion of waste. Of that, the Institute of Medicine says, 27% is due to unnecessary services. Instead of fee for service, Bertolini says, hospitals and doctors should be paid for a good outcome. “It would have to be partnered with Medicare,” he says. “That starts to get after all that inefficiency and fraud.”
Focus on the heavy users: Bertolini points out that 5% of Medicare patients are responsible for 43% of the $550 billion spent on the program — and says that trend is similar in the broader population of patients. To find big savings, you have to target where the big money is being spent, and you can do that by focusing on one disease: diabetes.
Aetna is encouraging its employees to stay healthier by offering a $300 premium reduction if they pass a test that measures vitals like waist size, glucose levels, and blood pressure. If a worker’s spouse passes the test, the employee gets another $300 incentive. (Research shows that a healthy spouse encourages good habits at home.) That and other programs have helped. Aetna’s employee health care costs fell by 7.5% last year, while the national average has been closer to a gain of 5% to 6%.
Restructure the delivery system: “Send all the hearts to the Cleveland Clinic. Send all the cancers to Memorial Sloan-Kettering,” he says, laying out a plan to develop regional centers of excellence around the country. And reward the institutions that produce better outcomes.
Without assessing any of Bertolini’s proposals, this observer notes with interest that none of these ideas has anything to do with access to insurance.