Health System Transformation

toddSpring 2013

The Case for Positive Change in Health Care

By Elizabeth Caldwell

UAMS is an engine of innovation

UAMS is an engine of innovation

As the United States continues to grapple with challenges in the way health care is provided and paid for, UAMS is leading as an engine for positive change.

Under the umbrella of translating science to better health, UAMS researchers, physicians and educators are working together in wide-ranging ways to contribute to solutions that lead to better health and more efficient delivery of health care at a lower cost.

Payment reform is, and will continue to be for some time, the pre-eminent issue for the nation and Arkansas, UAMS Chancellor Dan Rahn, M.D., and other Arkansas health care leaders say.

Medical spending in the United States almost doubled in the last decade, reaching $2.6 trillion in 2010, according to the federal Centers for Medicare and Medicaid Services (CMS). In Arkansas, 25 percent of 19-64 year olds are without insurance, rising to 40 percent in some counties.

But tied to reining in health care costs is the need to better manage chronic conditions, which account for a large percentage of costs.

Challenges, too, are seen in how to handle the hundreds of thousands of patients who will be newly insured through the federal health care reform legislation known as the Patient Protection and Affordable Care Act. The Arkansas Legislature is wrestling with expansion of the Medicaid roles as allowed under that same Act. An innovative private option has been approved in principle by the U.S. Department of Health and Human Services.

Meanwhile, the Institute of Medicine reported last year that an estimated 30 percent of total health care costs are waste through unnecessary and redundant services, lost opportunities for care prevention, poor care coordination and fraud.

In short, Arkansas’ — as well as the nation’s — health care system is unsustainable. System redesign is essential, Rahn said.

“We are entering a time in which there are almost certainly going to be some fundamental changes in health care,” Rahn said. “The primary drivers are financial, but they are enabled by advances in science and technology.”

UAMS is addressing these core issues in many ways. In 2008, the state’s only academic health center began implementing the model of care called the patient-centered medical home so a patient’s primary care physician can better monitor chronic conditions while reducing costs.

In spring 2012, Arkansas was selected for the Comprehensive Primary Care Initiative that is paying providers to improve coordination of care.

And in fall 2012, the state began paying providers for “episodes of care” rather than the traditional “fee for service” as incentive to manage costs for treating five conditions – upper respiratory infections, total hip and knee replacements, congestive heart failure, attention deficit hyperactivity disorder and pregnancy.

In other advances, UAMS Medical Center this year began participating in the State Health Alliance for Records Exchange (SHARE), giving health care providers throughout the state secure access to electronic patient health information to

improve safety and reduce duplicate testing.

Interprofessional education, personalized medicine, patient-centered outcomes research and a pledge to ethical treatment of patients and their health information are other ways UAMS is involved in system redesign.

Wrapping it all together is a commitment to patient- and family-centered care, which is improving the way health care professionals interact and communicate with those they serve, resulting in shorter hospital stays and lower costs per visit.

“These are not isolated, separate, disconnected initiatives, but they all fit together to support our overall mission,” Rahn said.