WisBusiness: Health care expert sees transparency, cutting waste as keys to true reform

By MaryBeth Matzek

For WisBusiness.com

APPLETON — With the U.S. Supreme Court hearing arguments this week over the future of the Affordable Care Act, the 60-plus people attending the St. Norbert College CEO Breakfast Series on Wednesday in Appleton were waiting to hear what Dr. John Toussaint, CEO of the ThedaCare Center for Healthcare Value, had to say.

“I have no idea what the court will decide, but I do know that whatever they decide it’s not going to fix the problem we have in this country that health care costs too much,” said Toussaint, who is also CEO emeritus of ThedaCare, an Appleton-based health care system, and a national speaker and author on health care improvement, payment reform and transparency. “We have to make some fundamental changes to fix what’s wrong.”

And what’s wrong is that health care spending continues to go up. In 2011, 18 percent of the nation’s GDP was spent on health care. That’s up 2 percentage points from the year before.

“We need to do something or we’re going to bankrupt ourselves,” Toussaint said. “Costs are out of control.”

The best way to control costs is to reform the system, drive out waste and bring more overall transparency to the market, Toussaint said. “What we have right now is a dysfunctional system,” he said.

Putting patients at the center is the first critical step toward breaking down the silos between different providers and departments.

The next step is to share information with consumers about costs and outcomes, Toussaint said. Two organizations in place – Wisconsin Health Information Organization and the Wisconsin Collaborative for Health Care Quality – are doing that now in Wisconsin, but many consumers are not aware.

“There’s such a wide range of costs out there in the state. Our data shows the cost of a knee replacement could be as low as $17,000 or as much as $55,000 depending on where you go. Consumers need to know that and start asking questions,” he said.

Another way to repair the health care system is change how providers are paid, Toussaint said. Some organizations are experimenting with different options, such as bundle payments (where there is one cost for an entire procedure from beginning to end) and rewarding doctors for providing a higher quality of care.

“For example, if last year it cost X amount to treat 20 patients with diabetes and this year you are able to treat those same 20 patients for less, you earn a bonus. And all of this is done with improving care and outcomes,” Toussaint said. “There are a lot of pilots out there to test new ways for how to pay for health care. No one knows the answers yet. We just have to keep experimenting to see what will work best.”