About Us
The Problem | The Goal | The Solution | Why Hasn't This Been Done Before?
At the same time, we pay far more for health care than any other country. US per capita health care spending is almost double that of many of the highly developed countries we consider our global competitors. And we're paying more and more all the time.
The problem is not with the quality of our doctors or facilities. Indeed, North Carolina in particular has extraordinarily well qualified physicians and world-class hospitals. The problem is the structure of the American health care system.
The system is not designed to engage patient and physician in an ongoing relationship to promote health and manage chronic disease. So a patient often receives inconsistent care, conflicting advice, adverse drug interactions, and unnecessary complications.
To make matters worse, the structure of health care in America is highly fragmented. There are dozens of major insurers, each with many different coverage options. Each insurer has different requirements for physicians. Therefore, patients may receive different treatment depending on which company provides their coverage, and which plan they have. In addition, each insurer requires different paperwork. The result is that physicians must spend far too much time on non-medical tasks.
Modern medical practice also requires physicians to work more quickly than many would like. Doctors often can't spend enough time with each patient to take all the steps needed to help patients become healthier.
Finally, chronic diseases, such as heart disease, asthma and diabetes, are among the most prevalent, costly, and preventable of all health problems. Nearly 80% of all health care costs can be attributed to the treatment of chronic diseases. While there is broad consensus on the best way to treat various diseases, we do not provide adequate support to physicians to ensure that they deliver this best care.
We agree that:
First, we have the award winning Community Care of North Carolina. Community Care received the 2007 Harvard University "Innovations in Government Award" for the extraordinary delivery of health care to Medicaid recipients. It's already saved the state hundreds of millions of dollars, while improving the health of tens of thousands of citizens. Over half the primary care physicians in the state already participate in Community Care. We will use and build on the infrastructure of Community Care to support physicians throughout North Carolina.
Second, the Area Health Education Centers (AHEC), the health education arm of the state’s four excellent medical schools, provides physician education in all one hundred counties. No other state has this resource.
Third, North Carolina is home to world class medical centers, and some of the most highly trained physicians and medical experts anywhere.
Finally, and perhaps most important, virtually all the members of our health care community – the North Carolina Medical Society, representing the state’s physicians; the North Carolina Hospital Association, representing the state’s hospitals; the state’s insurers, led by Blue Cross Blue Shield of NC, the North Carolina State Health Plan, and the State Division of Medical Assistance; the finest medical experts at our world class institutions; the North Carolina Institute of Medicine; and many others – have now agreed to join together to transform the way we deliver health care. Each has agreed to put aside its own way of doing business for this larger goal. By working together, we can create a new structure of health care delivery in North Carolina – something no one has accomplished before.
Once "best practice" standards for these five diseases have been established throughout the state, we’ll systematically add new diseases and improve our results with the old ones. Our goal is nothing less than the finest medical cares in the world.
And we can save billions of dollars in the process. By catching medical problems before they get worse and treating those problems effectively, we will substantially reduce the cost of health care. Those savings can then be invested in any number of productive ways, including providing coverage to more citizens. Better health care and improved health for our citizens are critically important goals. But if this program reaches its potential, it will do much more. Healthier people are more productive and happier. Parents may have more years with their children. Workers will accomplish more and earn more on the job. They can maintain more of their savings for productive uses.
American Health Care Must Be Greatly Improved
Americans like to think we have the best health care system in the world. Unfortunately, the evidence does not support that view. Both the Institue of Medicine and the RAND Corporation have concluded that Americans receive the reccommended care for their conditions only about 50% of the time.At the same time, we pay far more for health care than any other country. US per capita health care spending is almost double that of many of the highly developed countries we consider our global competitors. And we're paying more and more all the time.
The problem is not with the quality of our doctors or facilities. Indeed, North Carolina in particular has extraordinarily well qualified physicians and world-class hospitals. The problem is the structure of the American health care system.
The Problem - The Structure Of Our Health Care System Is A Barrier To Effective Care
Our health care system is based around treating the problem of the moment. A patient is ill - and so goes to the doctor. In many cases, patient and physicians meet for the first time in the examining room.The system is not designed to engage patient and physician in an ongoing relationship to promote health and manage chronic disease. So a patient often receives inconsistent care, conflicting advice, adverse drug interactions, and unnecessary complications.
To make matters worse, the structure of health care in America is highly fragmented. There are dozens of major insurers, each with many different coverage options. Each insurer has different requirements for physicians. Therefore, patients may receive different treatment depending on which company provides their coverage, and which plan they have. In addition, each insurer requires different paperwork. The result is that physicians must spend far too much time on non-medical tasks.
Modern medical practice also requires physicians to work more quickly than many would like. Doctors often can't spend enough time with each patient to take all the steps needed to help patients become healthier.
Finally, chronic diseases, such as heart disease, asthma and diabetes, are among the most prevalent, costly, and preventable of all health problems. Nearly 80% of all health care costs can be attributed to the treatment of chronic diseases. While there is broad consensus on the best way to treat various diseases, we do not provide adequate support to physicians to ensure that they deliver this best care.
The Goal - Improve The Way We Treat Patients (With A Special Emphasis On Chronic Disease)
The North Carolina Healthcare Quality Alliance is a collaboration of virtually all the leading organizations in the delivery of health care in North Carolina.We agree that:
- We know how to deliver the best health care in the world.
- There are comprehensive, carefully studied and well-understood "best practice" standards for treating many chronic diseases.
- However, many patients do not receive this "best practice" care. Physicians do not have the systems or support they need to systematically deliver the best one.
- By providing the appropriate systems and support to medical practices across the state, physicians can streamline and improve the treatment of chronic diseases.
- Systematically improving standards will make people healthier and save money.
- 80% of health care costs are spent treating chronic diseases (diabetes, asthma, heart disease, etc.)
- Systematically adopting "best practice" standards will result in healthier patients and will substantially reduce costs.
- For example, if medical personnel systematically provide the most effective preventative care, many medical problems can be addressed before they become serious. Many patients will be able to avoid hospitalization and other difficult and expensive interventions.
- To deliver the highest quality health care, we must make structural changes in the health care system.
- Medical experts must reach broad agreement on how to best treat each chronic disease.
- All participants in the health care systems must cooperate – including physicians, hospitals, and insurance companies – to create a consistent statewide program of best practice care for all patients.
- We must create a well designed system to educate and support physicians in providing best practice care.
- We must remove the multiple and sometimes conflicting requirements that stand in the way of physicians adopting best practices.
- There must be systematic review of the way in which patients with chronic diseases are treated, including regular collection of data, so that physicians can follow their progress and patients can receive the care they need.
The solution – a system to bring best practice care to all North Carolinians
- We have selected five common chronic diseases – diabetes, asthma, hypertension, congestive heart failure, and heart attack – as the first diseases to include in the initiative. All are widespread, well understood diseases, and are very costly to treat.
- A group of the foremost medical experts in North Carolina have formulated evidence-based "best practice" standards of care for each disease. They have unanimously agreed on a single set of quality measures – the basic steps each physician should take when treating a patient with one of these diseases.
- Every primary care physician in North Carolina will be invited to participate in this program. Those that join will be provided with training and support programs to help them incorporate "best practices" into their practice. They will also be given tools for patient support, so that patients can play a larger role in maintaining and improving their own health.
- The largest health insurers in North Carolina have agreed to support this program – so patients across that state, regardless of who pays for their care, can receive the same "best practice" care.
- Participating physicians will report the data supporting their work in implementing the standards. Each physician can then follow their progress in providing best care to patients.
So, if this is such a good idea, why hasn't it been done before?
Some of the elements of this program have been attempted in pilot programs around the country. But no one has ever attempted to do what North Carolina is doing today. North Carolina is already a national leader in health care. In addition, we have several factors in place that make us uniquely positioned for this revolutionary program to succeed.First, we have the award winning Community Care of North Carolina. Community Care received the 2007 Harvard University "Innovations in Government Award" for the extraordinary delivery of health care to Medicaid recipients. It's already saved the state hundreds of millions of dollars, while improving the health of tens of thousands of citizens. Over half the primary care physicians in the state already participate in Community Care. We will use and build on the infrastructure of Community Care to support physicians throughout North Carolina.
Second, the Area Health Education Centers (AHEC), the health education arm of the state’s four excellent medical schools, provides physician education in all one hundred counties. No other state has this resource.
Third, North Carolina is home to world class medical centers, and some of the most highly trained physicians and medical experts anywhere.
Finally, and perhaps most important, virtually all the members of our health care community – the North Carolina Medical Society, representing the state’s physicians; the North Carolina Hospital Association, representing the state’s hospitals; the state’s insurers, led by Blue Cross Blue Shield of NC, the North Carolina State Health Plan, and the State Division of Medical Assistance; the finest medical experts at our world class institutions; the North Carolina Institute of Medicine; and many others – have now agreed to join together to transform the way we deliver health care. Each has agreed to put aside its own way of doing business for this larger goal. By working together, we can create a new structure of health care delivery in North Carolina – something no one has accomplished before.
Once "best practice" standards for these five diseases have been established throughout the state, we’ll systematically add new diseases and improve our results with the old ones. Our goal is nothing less than the finest medical cares in the world.
And we can save billions of dollars in the process. By catching medical problems before they get worse and treating those problems effectively, we will substantially reduce the cost of health care. Those savings can then be invested in any number of productive ways, including providing coverage to more citizens. Better health care and improved health for our citizens are critically important goals. But if this program reaches its potential, it will do much more. Healthier people are more productive and happier. Parents may have more years with their children. Workers will accomplish more and earn more on the job. They can maintain more of their savings for productive uses.
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