Posted by: knightbird | May 7, 2012

Is More Money Always The Answer?

I am listening to a report that is recommending a budget increase of $26.1 billion for American Indian/Alaska Native Tribal health funding over the next 10 years. I hear absolutely nothing about performance and quality improvement. We assume that we are already operating at optimal efficiency when talking about health care. I wrote a paper estimating the potential for savings in the tribal health system that will work for the U.S. health system as a whole. I sent the paper to the President, the Secretary of Health and Human Services and the Director of the Indian Health Service. I get the polite thank you for writing letter from the President, and nothing from the Secretary or Director. Politicians ask us for ideas, but they don’t really mean it.

What is the solution? Here is what I believe. We can reduce expenditures by an initial 10% through adoption of lean, everywhere in a health care system and not just the hospital or clinic. Other lean healthcare leaders believe we can reduce it by as much as 50%. Lean design will provide another 5 to 10% reduction over time. Increased throughput (performance improvement) will add another significant reduction in cost. The figure I see and we have experienced is at about 30%. This may actually be where the other lean leaders calculate the other 40% of savings but I haven’t seen any explanation of where the savings come from so I will separate them out. This assumes we have the same patient base we currently have, or an increasing base with greater development of chronic disease. The next set of savings depends on reducing patient need for services.

About 30% of patient complaints are somatic (and this could be higher). This group would benefit from an integrated primary care/behavioral health system. By channeling this group out of the primary care system we will have a reduction in patient visits. By teaching them to manage the stress induced medical symptoms, they will be healthier.

My final recommendation has to do with an intensive restoring our health initiative. By helping patients reduce their “Toxic Stress” we should be able to reduce chronic disease and improve patient health.

There you have it. We would need fewer facilities, fewer providers and smaller facilities. Yet we only hear about needing more money to fund a system that works poorly.

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