We need to make some changes to change health care

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health Care, Inc., a nonprofit health plan that covers more than 1 million New Englanders. Baker blogs regularly at Let's Talk Health Care.

One of the reasons the operating model in health care doesn’t change much over time is pretty simple: most of the people who think about it, write about it, work in it and study it have trouble seeing the model any differently than they see it today. I was struck, therefore, by Hebrew Senior Life’s Len Fishman the other day when he and I served on a panel at the 30th annual meeting of the Massachusetts Health Data Consortium. We were told to discuss health care 30 years from now — me from the plan perspective, and Len from the long term care perspective. I went pretty far out there in my remarks, imagining, among other things, a world in which there were no health plans at all(!). Len did too. His presentation on the future of long term care could not have looked more different than what we have today. He literally re-imagined the whole thing. It was startling — and refreshing.

This question — is the future just like the past, or something different — was raised again for me earlier this week when Brian Rosman — a good guy with whom I almost never agree — posted a blog on the Health Care for All Web site that basically said that more publicly available information on health care cost and quality could/might/will lead to higher costs and higher prices, because no one really cares about costs, and if they do, they’ll flock to higher cost options, because they’ll think they’re better than lower cost ones.

It might be, in the short term, that more publicly available data on cost and quality will lead to higher costs. Hard to imagine, given how high costs are now, but certainly possible. Also hard to imagine, given the amount of chatter, mythology, rumor and competitive intelligence about who gets paid what by whom that already existing among people “in the biz.” For the most part — and I’m being overly simplistic here to make a point — the group who will learn something new when the MA Health Care Quality and Cost Council data becomes public is, well, THE PUBLIC. And I simply cannot see how a state policy maker — or a practicing doc — or an advocate like Brian — or an employer — or a health plan — or even a provider organization — won’t be better off over time knowing what’s really going on under the covers.

I was re-reading, for about the fourth time, Atul Gawande’s first book, Complications, the other day, and I came across his discussion about the rise of the patient in making difficult decisions about his or her own health care. Gawande points out that before the mid-1980s, the idea that a patient would have anything to say about his or her treatment or care was preposterous. Patients didn’t make health care decisions, doctors did. Period. And yet, here we are, twenty years later — in a far more powerful and complex system than the one we had in 1985 — and patients do have a much bigger say in what they get and what they don’t than they did twenty years ago. Today, clinical decision-making is more transparent — and shared — between patient and caregiver than it was 20 years ago. And I would argue we are better off as a result.

This whole cost/quality thing in health care needs to change. We need to take some chances. We need to presume that smart people — and I don’t mean just consumers, I mean everybody — will make better decisions about value, about cost and about quality — than they make today, if they have more and better data. It has always worked this way as far back as I can remember. There may be bumps and bruises in the short term. There always are. But I see no reason why it won’t work over time this time, too.