“Let’s talk about “New Rules.”


“Let’s talk about “New Rules.”

No, we’re not referencing Bill Maher.  The Commonwealth Fund – a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency – has posted a blog titled “New Rules to Guide Healthcare Redesign citing how many health system leaders say they need new rules in order to redesign how care is provided to patients.

Given that most of these rules derive from an organization respected world-wide for its commitment to quality improvement in health care, the Institute for Healthcare Improvement, the rules are hard to argue with.  Some, however, we particularly think are worth noting.  For instance:

  • Standardize what makes sense.”  This proposed new rule would certainly be high on our wish list – particularly in terms of measuring health care outcomes.  The physician groups we work with tell us they are being pulled in as many different directions as there are health plans.  We don’t understand why.  Bridges to Excellence already exists and points the way to better outcomes at lower costs.  For assessing health plan performance we have eValue8 – created by business coalitions and employers like Marriott and General Motors expressly so that we would have standards for our RFIs and RFP.  And for hospital standards we have The Leapfrog Group’s Safety Score.  We think these are the best of the best and encourage all employers to use these tools in purchasing care.
  • Assume abundance.”  We not only agree with this proposed new rule, we would propose moving itnear the top of the list.  Waste in health care – typically estimated to run between 35% and 50% of all health care spending – is notorious and little if any improvement has been seen since the National Institute of Health came out with its frightening To Err is Human in 1999.  The marvelous news here is that we can actually get better care by spending less money.
  • Eliminate walls.”  The National Institute on Health’s follow-up To Err is Human, Crossing the Quality Chasm, identified fragmentation as the major reason for the horrific waste in health care.  What can employers do about that?  Much more than you think.  Begin by insisting on bundled pricing – a payment model that forces the various physician groups, providers, and hospitals involved in complex procedures – to work together for better outcomes or lose money.

Which of the “new rules” would we most agree with and promote for employers?  Easy; “Change the balance of power.”  Funding virtually all commercially purchased health care, employers must change the way they buy health care.  They must proactively purchase health care, not just passively pay for it – which is to say, they need to stop delegating their purchasing power to third parties.  Self-funded employers in particular need to lead the way.  And they can do so by starting with the three new rules cited above.


Robert J. Smith