Improving Quality
NCHQA

The Problem

Americans like to think we have the best health care system in the world. Unfortunately, the evidence does not support that view. Both the Institute of Medicine and the RAND Corporation have concluded that Americans receive the recommended 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.

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 physician is typically compensated only for providing specific services, not for taking time to learn about the needs of the patient. In addition, patients may see several different doctors, none of whom are aware of the treatment or recommendations provided by the others.

The system is not designed to engage patient and physician in an ongoing relationship to promote health. This often results in inconsistent care, conflicting advice, adverse drug interactions, and unnecessary complications. There is wide consensus that we must correct a number of structural flaws in the health care delivery system. For example:
  • 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 payment system often provides incentives for unnecessary and expensive tests and procedures so that the cost of care escalates rapidly. But the system often doesn't pay for what's often needed the most: access to basic primary care, prevention, disease management and patient education and support.
  • The system is disconnected - multiple physicians treat patients without knowing what care has been provided by the others. Tests results are not shared, prescriptions can be duplicated or interact harmfully. And perhaps most important, care is not coordinated - there is no one to follow up with the patient to ensure that the patient has the support needed to get well and stay well.
  • Different insurers have different requirements, different forms, and different procedures, resulting in much more paperwork and higher administrative costs for doctors and insurers alike. At the same time, the resulting paperwork and administrative burden drains hundreds of hours of each physician's time each year -- time that could be spent providing care.


The Solution

We believe that leadership and coordination can transform health care. In North Carolina, NCHQA provides a mechanism to bring all key players together to take unified action to address problems in the health care system - doctors, hospitals, insurers and others all working toward common solutions. We already have the tools we need to build a unique twenty-first century heath care system in North Carolina and what can quickly become the finest health care system 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.


North Carolina's Unique Strengths

First, health care professionals in North Carolina have a long history of working together to provide cooperative, coordinated care. Thanks to the pioneering efforts of Community Care of North Carolina (CCNC), physicians, nurses, pharmacists, hospitals, health departments, social service agencies and other community organizations in North Carolina are experienced in collaborating to provide patient-centered care for Medicaid beneficiaries through the Medical Home model. This experience in cooperation at the local level has laid a solid foundation for future efforts to improve the quality of care delivery throughout the state.

Second, we have the Area Health Education Centers program (AHEC), the health education arm of the state's four excellent medical schools. AHEC provides physician education and hands-on support for physicians to improve the care provided in their practices. AHEC operates in all one hundred counties and is the largest regional health professions network of its kind in the country.

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 (Medicaid); the finest medical experts at our world class institutions; the North Carolina Institute of Medicine; and many others joined together through NCHQA to work toward transformation of the way we deliver health care. Each 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. Our goal is nothing less than the finest medical care in the world.

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