Waste Not, Want Not: A Vision for Health Care in America

June 19, 2009

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By Rita M. Richardson, MD

The American Academy of Neurology is collaborating with the National Quality Forum (NQF), the organization in the forefront of quality improvement initiatives in health care.

"The mission of the National Quality Forum is to improve the quality of American healthcare by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance, and promoting the attainment of national goals through education and outreach programs."
The NQF recently held a conference, "Waste Not, Want Not: The Right Care for Every Patient," in Cleveland, OH. I participated in this event, representing the Academy's Quality Measurement and Reporting Subcommittee.

Denis Cortese, MD, President and CEO of Mayo Clinic, in his keynote speech, articulated his vision of a US health care system without waste. He emphasized that the health care system would do best to design treatment based on a learning system—not from processes, but from outcomes-based treatment and lasting value. The system must be based on learning how to better deliver value, defined as quality/cost, or, more specifically, outcomes, safety, and service/cost over time.

The US spent $2.3 trillion on medical care in 2007, representing 16.7 percent of our national GDP. However, value, as defined above, is woefully absent in much of today's health care delivery. We've all seen the great disparities in practice throughout the US: There is a striking lack of correlation between utilization of medical services and quality of care. Clearly, more medical services do not necessarily lead to better medical care, as illustrated in the graph below.



Source: MedPAC analysis of county-level fee-for-service expenditures and other data from CMS, and Jencks et al. 2003. ("Report to the Congress: Variation and Innovation in Medicare, June 2003.")

National Priorities Partnership

The National Quality Forum convened the National Priorities Partnership in order to fundamentally change the way that we deliver care in our nation. The partnership brings together 28 major national organizations that influence every part of the health care system, including health care organizations, health care professionals, community members, payers, suppliers, and government organizations. The goal is to transform the nation's health care system to ensure all Americans have access to safe and affordable healthcare.

The six national priorities include:

  • Engage patients and families in managing health and making decisions about their care
  • Improve the health of the population
  • Improve the safety and reliability of America's health care system
  • Ensure patients receive well-coordinated care within and across all health care organizations, settings, and level of care
  • Guarantee appropriate and compassionate care for patients with life-limiting illnesses
  • Eliminate overuse while ensuring the delivery of appropriate care

The National Priorities Partnership is currently developing work groups to implement these priorities. Small-scale improvement projects will be used to pilot processes that deliver good outcomes and efficiencies, which can be applied to similar needs and delivery systems across the US.

The Academy is committed to being a leader of health care reform. We are aligning our quality measures development to participate fully in the National Priorities Partnership. We have already developed measurement sets for stroke and epilepsy, and are currently working on Parkinson's disease and multiple sclerosis. Further measurement sets will include dementia, headache, and patient safety.

For more information on our quality measurement development, or to get involved, please contact Rebecca Swain-Eng, MS, Performance Measurement Program Manager, at rswaineng@aan.com, or call (651) 695-2808.

Author Disclosure

Dr. Richardson has nothing to disclose.