Ellen-Marie Whelan on "Bending the Cost Curve"

What is "bending the cost curve"?

When people talk about bending the curve, or the cost curve, they're talking about the rising cost of health care. And at this point in America the cost of health care is growing at such a rate that we're just not able to sustain it. It's been going like this for a while, but when we look into the future, it's rising at such a level that the economy will be devastated if it keeps going at the same rate. So when we talk about bending the cost curve, we're talking about looking at the rising cost of health care and bringing it down--having it not grow as much so it, in effect, bends the cost curve.

What can we do to bend the cost curve?

There's actually quite a few things that we can do to bend the cost curve, or to just decrease cost in health care. The first is looking at minimizing the waste--right now we have an enormous amount of waste in the health care system. In fact there are estimates that $700 billion of the care that is being delivered has never been documented to help people get better. So there's a lot of things that we can look at in the system--at what we're spending the money on, and try to make sure that those things actually help get patients better.

The second thing we have to do, is we have to look at offering care that's more efficient. Care that actually costs less, while we improve outcomes. It might sound like something that's almost impossible to do, but it's not. Take for example someone that has asthma: if we do a better job taking care of someone with asthma in the doctor's office--seeing the same person, being able to talk to them about what's happening with their disease--we can pretty much predict that we can decrease the number of times that they will have to go to the emergency room. That increases the outcomes, while it decreases the costs of actual emergency room visits.

How can health reform legislation help?

There's quite a few things we can do in the health reform legislation that's going through Congress now. The most important that we should do is change the way we pay for health care. Right now we pay for individual tests, individual service--every time someone goes to see a doctor, the doctor gets a reimbursement for it. Instead, what we need to do is tie that reimbursement to someone getting better. And that might mean that you spend more time talking to the provider; it might mean more time talking to a nurse about negotiating a complicated health care system, and less time just running to get individual tests. And there's a couple things that's going through the legislation that will change the way we pay for health care and do a better job incentivizing the coordination of care, and looking at the patient's outcomes and making sure that they're getting better instead of just doing more tests. In health care, many, many times, more is not always better.

The second thing we can do is better use of providers that are more efficient providers. And for example--primary care providers. Right now, our doctors and nurse practitioners that are providing primary care don't make anywhere near as much money as a specialist. And we know that if you spend more time going to a primary care doctor for many chronic diseases like diabetes and asthma, that we can decrease hospitalizations. So the health care legislation will be paying more for primary care providers.

And the last thing that the health care reform legislation can do is use better health information technology. And that will help keep track of patients as they go through the complicated system. It will also help prevent things like duplicate lab tests and x-rays. You get the same lab tests sometimes when you go to every doctor, and instead, all of that can be collected and we can track it in a way. We can also track better outcomes. After all, the point of all of this is just having people be healthier at the end of their visit to a health care provider.