Controlling Health Costs Is Complicated By Rising Demand For Care

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(Host) As Vermont debates changes to its health care system, containing the escalating costs of care and services remain to be accomplished.  As part of our special series, "Vital Signs," VPR’s Jane Lindholm reports.

(Lindholm) There’s no disputing that health care costs are rising fast.  A million dollars a day fast, just in Vermont, according to the governor.  Annual health care expenditures in the state are expected to top 5.9 billion dollars next year.  Richard Slusky, the state’s payment reform director, says bending the cost curve will require attacking this issue from every angle:

(Slusky) "And that includes delivery system reform, which is embedded in the Blueprint for Health in Vermont. The payment reform methodologies: moving from fee-for-service to value-based payments.  Using health information technology better so providers can understand and compare their performance and have opportunity for change.  And then patients need to realize they have some responsibility in this as well."

(Lindholm) The challenge is finding reforms that everyone can agree on.  Dr. Norm Ward, a physician and Medical Director of Case Management for Fletcher Allen Health Care, says he believes Vermont has taken some steps in the right direction, like its chronic care initiative.

(Ward) As a primary care physician, for example the Blueprint for Health has made great strides in finally putting into the hands of the primary care physician the tools, the people, the helpers, around us to provide better chronic care for people with diabetes, heart disease, mental health conditions.  We’re finally getting to the position of doing it right and doing it better."

(Lindholm) It’s a complicated issue: saving in one area might mean spending more in another.  And no one is really talking about diminishing absolute costs.  The discussion is really focused on how to change the whole system-from getting patients to make healthier choices to reforming our payment systems-in a way that will stabilize and hold costs.  But Dr. Norm Ward cautions that progress may be slow, even if comprehensive changes are made:

(Ward) "There are a lot of people who are not currently accessing generally accepted screening-type tests, interventions to keep them healthy.  So as we start to save money we’re also going to be improving access to people and that’s going to be counter-balancing these savings so things may continue to go up before they can go down.  There’s a huge time lag that we better be prepared for because it’s not going to be an instant overnight success."

(Lindholm) Dr. Ward’s message, that we may have to watch costs rise even as we attempt to control them, may be a bitter pill to swallow.  For VPR news, I’m Jane Lindholm.

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