Wednesday, February 4, 2015

Cost, Quality and Access in Health Care: Are All Three Out of Reach? Really?

Maybe the Disease Management Care Blog has been wrong.  And maybe there are implications for health reform.

The DMCB explains.

When it lectures at population health conferences, it patiently explains that health care data analytics will always involve trade-offs between speed, accuracy and detail.  For example if it wanted insight on the quality of care for a cohort of persons with diabetes, it could want the results tomorrow (speed), that captured 100% of the population (accuracy) and included standard deviations as well as age and sex breakdowns (detail). 

Analytics always must decide to pursue two out of three.  For example, the DMCB might want detail and accuracy, but that will take extra time. 

And so it goes.

An example from a parallel universe is the automobile market.  One Mr. Ford got past selling cars that were any color the customer wanted so long as they were black, Detroit infamously forced consumers to make trade-offs in speed, safety, gas mileage and quality.

2015 may be a watershed year where much of the DMCB's trade-offs are false choices. 

Bob Dylan argues that global consumers can have speed and safety and mileage and quality; he may have a point.

Returning to the health care industry, the DMCB wonders if the electronic record's expanding ability to capture patient detail combined with logarithmic growth in computational processing power will give providers the ability to hit "Ctrl-F1" and get an immediate, detailed and comprehensive on-screen report on the status of all persons with a particular attribute, like the presence of diabetes.

Which brings the DMCB to the infamous health care "iron triangle" of quality, access and cost.  The DMCB believes that the re-emergence of narrow insurance networks is simply a trade-off of access in exchange for quality and cost.  On the other hand, if consumers demand access and quality, they might have to settle for the high out-of-pocket costs of a stinky "bronze plan."

But here's the rub.  If Detroit can move the needle on automobiles and if the electronic record and supporting infrastructure is finally reconciling speed, accuracy and detail, who says the health care industry won't eventually crack the quality, access and cost conundrum?  The DMCB thinks it may take a while (Detroit took decades) but if the current pain over Obamacare eventually results in getting all three, maybe it will have been worth it.  Maybe it is within reach.

Just maybe. We'll see.

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