Column: Quality is top priority, but affordability is right behind

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By Tarek Elsawy

The cost of medical services is a hotly debated topic in congress, in state houses, in board rooms, and in living rooms everywhere. Focusing on the cost of something as critical as health care may feel unseemly to many; but cost matters, especially in this age of high-deductible health plans, exorbitantly expensive pharmaceuticals, and state budgets straining under the weight of rising healthcare spending.

In 2018, Medicaid alone comprises nearly 30 percent of our state budget. Nationally, healthcare spending is expected to account for nearly 20 percent of the gross domestic product by 2025.

The rise in healthcare spending is unsustainable and drains other essential services. And we know that higher-cost care very often does not result in better outcomes.

The Massachusetts Health Policy Commission – an independent state agency charged with monitoring health care spending growth in Massachusetts – recently published a report that showed stunning variation in the cost of services provided in 14 large Massachusetts health systems. The commission reported that the highest-cost system spends 32 percent more per patient than the lowest-cost system. In hospital outpatient spending alone, the highest-cost organization is twice as expensive as the lowest-cost group.

Multiple factors were cited as driving this cost variation, including price-per-service, utilization rates, patient income levels, and “practice patterns and culture”, which refers to the clinical culture within a health system that influences care delivery.

In nearly every cut of the data, the HPC found that Reliant Medical Group provides care at a lower cost. In isolation, this distinction is not all that meaningful and could be misinterpreted by those who perceive lower-cost care to mean lesser care.

This is why I am most proud that Reliant also consistently exceeds national standards in the 30 healthcare quality measures defined by the National Committee for Quality Assurance. In fact, we rank in the 90th percentile in most national quality measures. In patient satisfaction, we typically perform better nationally than 80 percent of groups like us. We do this while more efficiently managing costs for patients, employers, insurers, and our state and federal governments.

At Reliant, we believe that managing both the quality and the cost of care is, indeed, about efficiency; but it is also about being socially and clinically responsible. Our clinical culture is based on the premise that providing evidence-based, proactive ambulatory care is the best way to keep patients healthy and out of high-cost healthcare settings. We avoid duplicative or unnecessary medical testing, which drive up costs and provide no clinical benefit to patients.

We assertively manage chronic conditions, like diabetes and heart disease. We optimize our electronic medical record so that everyone on the treatment team has access to a patient’s information. And we try to provide as many medical services as possible within our system to avoid the occurrence of fragmented, uncoordinated care.

In healthcare, quality is job one; but everyone in healthcare needs to be concerned about the cost of care. Caregivers should rigorously pursue clinical excellence, while always being mindful that we are stewards of limited healthcare resources. As a physician, what I want for my patients, my loved ones, and myself is excellent healthcare delivered at the lowest cost possible.

While thinking about cost in the context of medical care can be uncomfortable, the inescapable truth is that all of us experience real healthcare value when high-quality care is coupled with the efficient and responsible management of costs. Providing and demanding valued-driven care is our collective responsibility and the only way we will be successful in curbing rampant healthcare spending.

Tarek Elsawy is the president and CEO of Reliant Medical Group.