GHP Home >> Open Mike
Open Mike - 2010

Decreasing “unwarranted” variation in clinical care
March 24, 2010

As you read this, we are in the midst of unprecedented reform to our national health care system. The changes are complex and we are actively figuring out what it means for our organization and our patients. While it will lead to many challenges, I also believe it will create more opportunities for delivery systems like ours to focus on better ways to provide care. Our stories today about preference-sensitive care and shared decision making are timely and prime examples of how we are improving care, affordability, and patient satisfaction.

For more than 20 years, scholars at Dartmouth College have analyzed why health care costs vary so much by region. They publish their findings in a respected report known as the Dartmouth Atlas of Health Care. Over the years they’ve determined that more than 25 percent of all health care costs come from variation in the care provided that serves no clinical purpose.  (Of course appropriate variation does exist and serves a clinical purpose.) The Dartmouth researchers point out that more intensive care—and more expensive care—isn’t necessarily better care. In fact, in many cases outcomes are worse.

One reason health care varies by region is because of different regional care patterns (ie, medical culture) for certain procedures. The supply of providers and hospitals is also a factor. If a city has a lot of orthopedic surgeons, for example, then you’ll likely see more surgery for joint pain. 

Addressing unwarrented variation is further complicated by a category known as preference-sensitive care. For many conditions, there isn’t a single best treatment. Patients can choose between several viable options such as having an invasive procedure or taking a “wait and see” approach.

A classic example of a preference-sensitive condition is a retiree deciding whether to have knee replacement surgery or to go with medications and physical therapy. Caregivers must factor in the patient’s values and lifestyle preferences with the medical evidence and help the patient make the best decision for their needs and values.

Research shows that good communication from clinicians about options and consequences for preference-sensitive conditions makes patients happier with their treatment decisions and can decrease health care costs.

Under health reform, the federal government is exploring changing reimbursement to motivate health care providers to use proven, evidence-based practices. This shakes up the status quo. Recently articles in the New England Journal of Medicine and New York Times have challenged the Dartmouth Atlas’s research methods. At Group Health we’ve watched the debate with interest, but are convinced that the Dartmouth group is accurate in its key finding of no consistent link between costs of care provided and the quality outcomes of that care.

At Group Health we strive to practice medicine that’s based on evidence whenever possible. We are working hard to examine our own practice patterns, establish “best practices”,  and partner with patients around their care decisions.

Increasingly, we encourage patients to consider all the options and make an informed choice based on what we do know and the patient’s values and preferences. This is called shared decision making, and it’s a cornerstone of where we are going at Group Health.

During the past 18 months, Group Health has built new processes to promote shared decision making for preference-sensitive care. I’m proud that Group Health is finding ways to be part of the solution.Print

Open Mike Articles
  • 2012  
  • |  2011  
  • |  2010  
The Path To The Best Care At Lower Cost   12/01/2012
The US spends $2.7 trillion on health care every year. If our collective wallets feel lighter, that’s because $304 billion comes out of our own pockets. How can these kinds of costs be brought under control, without sacrificing quality of care?

Certainty   09/04/2012
Sustaining momentum in uncertain times can be hard, but one way to keep it up is to celebrate progress. I’m really proud to call your attention to a study published in Health Affairs today.

Affordable Care Act ruling brings stronger imperative to transform health care  07/11/2012
As important as the Supreme Court Ruling is for the future of health care, it’s really just one step in a process that started before the Affordable Care Act passed and will continue for a long time to come.

Only connect 05/16/2012
This spring I spent five weeks in clinical immersion all over our system. I had 34 small-group discussions with 172 different clinicians. In March, I shared some early insights at the half-way point. Now I want to wrap up everything I heard.

What if? 04/11/2012
What if the “new normal” doesn’t feel normal at all, for many years? I try to remind myself and others that the current turmoil in health care is driven by market forces—not politics—and can only be solved by directly addressing the market. Our “new normal” is all about reaching across silos to work with partners in new ways.

Business problem? Diagnose it.
03/21/2012
I’m about halfway through my 2012 clinical immersion. When I tried this last year it was new for all of us, and it felt right to start our conversations around values. This year I'm trying to dig a little deeper.

What will your legacy be?  02/24/2012
What a night! It felt terrific to see over 700 clinicians and special guests at the GHP Annual Meeting on February 15. “A Legacy of Leadership” was our theme for the evening, touching on our shared past, present, and future.

Performance matters  10/19/2011
Only nine Medicare Advantage plans in the country earned 5 stars overall, and Group Health Cooperative’s Medicare Advantage plan is one of them!

Looking back, and ahead: reflections on my first three years  9/17/2011
The last three years have passed quickly, largely because I’ve had such an amazing group of people to work with. What you’re capable of no longer surprises me. It inspires me.

Our people are our culture, and we’re constantly evolving  8/17/2011
One thing I’ve noticed since my last Q&A on Group Health culture with Scott Armstrong is that conversations like ours are spreading.

More than elbow room  7/6/2011
Growth is a good problem to have in turbulent economic times. But as I’ve heard in medical staff business meetings and conversations, growth is hard on daily life at work.

Erikson and Soman on partnership and growth  6/15/2011
Sustaining growth isn’t about Michael and I being leaders; it’s about teams of seasoned, excellent colleagues and leaders and clinical teams. We both have tremendous confidence in them.

The good, the bad and everything in between  5/11/2011
I went all over the state in March, talking with small groups of GHP physicians and other clinicians about critical issues. 

Why are we here?  3/23/2011
Easily eight out of ten of you mention that our philosophy of medicine—the way we practice—drew you here. And paired with the people and relationships in your workplaces, it’s a major thing that keeps you here.

Culture at Group Health: 7 questions for Scott & Michael  3/9/2011
Scott and I kicked off some fresh thinking about culture and respect for people at our Leadership Conference about five weeks ago. Recently, we sat down to check in with each other about it.

Put some passion in your workplace 2/17/2011
What satisfies you, motivates you, or makes you want to tell your friends and family about your day? Do you know how your co-workers would answer these questions? Talk to each other to learn from each other.

Sometimes growth don't feel like it should  1/28/2011
We know that taking on new patients—and engaging them in their own good health—takes time. But it’s what’s unique and important about our kind of medicine.

What will it take? You.  12/1/2010
About 350 leaders from the Group Practice and throughout Group Health gathered for the Group Practice Annual Fall Forum on November 12.

Demystifying clinical integration
11/3/2010
Clinical integration is the key, so let’s define what that phrase means.

Step back and take it all in. You’re making great things happen.  10/21/2010
In the last issue of Open Mike we had just learned that we had won the 2010 Acclaim Award from the American Medical Group Association.

Group Health sees a big jump in NCQA private plan rankings  9/22/2010
Group Health is one of the highest rated health plans and among the top 50 in the nation, according to the National Committee for Quality Assurance (NCQA).

Innovation is where we shine  9/8/2010
I am very excited to share that the American Medical Group Association (AMGA) has honored our work with its 2010 Acclaim Award.

Notes from the Colorado Health Symposium  8/11/2010
During the last week of July I traveled to the Colorado Health Foundation’s annual symposium in Keystone, CO.

Measuring up  7/28/2010
Quality. Ask a hundred people to define it, and you’ll get a hundred answers.

The risk and opportunity of Accountable Care Organizations
6/30/2010
Shared values, physician-led care models, and aligned incentives can bridge the distance between organizations in the world of accountable care.

Let’s start a conversation about our workplace  4/4/2010
People are our most important resource, our “secret sauce.”

Making the transition from “I” to “we”
2/10/2010
Last night the Group Health Permanente Annual Meeting left me feeling inspired and confident.

Looking ahead to 2010  1/13/2010
First, for 2010, our goal is as follows: We will lead the top delivery system in the state.

Other GHP Leadership Publications