In the last two years there have been robust conversations nationally about how to make sure all Americans have access to health care. However, as a nation we have not had the same robust conversation about what care we’re providing access to. Most agree the current state of our healthcare delivery system is unsustainable. There is underuse of life-saving preventive services and treatment for chronic diseases like diabetes and heart failure. Simultaneously, there is overuse and misuse of health care services that yield relatively little benefit and may cause harm. According to a study published in the New England Journal of Medicine in 2003, patients get about 55% of recommended care. This occurs in part because incentives in our system encourage volume of services over value of services, and in part because there is a lack of good medical information available when patients and providers are making decisions about care.
In light of these complex and costly shortcomings of our system, many believe the time is right to nurture new approaches outside of the usual and customary. One promising and innovative approach is to use the most recent assessments of clinical effectiveness, cost efficiency, and publicly held values to prioritize healthcare services covered by insurance. The concept is to construct smarter benefit packages that produce greater health per dollar spent at any price point.
Colorado currently has the opportunity through a grant from the federal government to explore this approach. The Engaged Benefit Design Pilot will demonstrate a new approach to healthcare benefits that relies more heavily on science in order to make it easier to get the care that works best and to avoid unneeded treatments. Health care is almost always paid for through shared resources, such as insurance or government, therefore promoting higher value care and discouraging unneeded treatments benefits everyone.