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Lauren Baer: We need to talk about quality of health care, not just who pays

Today, as we mark the anniversary of the shameful Republican vote to repeal the Affordable Care Act (ACA) — a craven move disgracefully supported by our current Congressman Brian Mast — pundits around the country will turn to health care.

But, what will inevitably be missing in the political debate over who pays for health care and how much is a discussion of the equally important issue of the standard of care Americans are receiving.

And that’s a problem.

For while it is undeniable that deductibles are too large and premiums too high, to focus on that issue alone is to ignore a critical concern: we are paying too much for care that is simply not good enough, especially for people with complex, chronic medical issues.

I know this is true, because for me it’s personal.

In 2013, while visiting a friend in Chicago, hundreds of miles away from her Florida home, my mother suddenly went into kidney failure. Choking up, my father told me to get on the first possible plane.

My mother was no stranger to hospital rooms, having been in and out of them ever since a 1992 car accident left her with debilitating injuries and medical complications. Over the next week, as we sat at her bedside with hospital staff, we painstakingly reviewed the list of more than 20 medicines that she takes every day, prescribed by nearly a half-dozen doctors.

Each pill was intended to improve her quality of life, but, as we learned, they could also interact in life-threatening ways.

Indeed, what her individual doctors hadn’t told us — or, more troublingly, had not pieced together — was that the particular combination of medicines my mother was taking could bring on sudden kidney failure.

My mom pulled through, but she has been in the hospital more than a dozen times since. Each time, we have the same painful conversation with hospital staff in which we recount her years of trauma, her multiple surgeries, and her long list of doctors who, despite their best efforts, don’t always effectively communicate with each other — or with her.

At home, we go over the different instructions of her many doctors and try to make sure that what each individual physician is doing to save her isn’t inadvertently making her worse. And we help my mom cope with the frustration of feeling like her doctors are making medical decisions without her participation or full consent.

My mother’s story is the lens through which I see health care in our country, and it shines a light on a problem faced by too many Americans: at the same time that we are coping with crippling medical bills and rising health care costs, we are also struggling to receive quality care. That needs to change.

The good news is that we know what works: models that treat patients and family members as part of the care team and puts patients’ preferences and needs — and their unique treatment history — first.

Indeed, patient-centered care is effective on multiple levels: actively engaged patients have better health outcomes and reduced health care costs. In a large randomized study, patients who received enhanced support for making their own health decisions had 12.5 percent fewer hospital admissions, 9.9 percent fewer preference-sensitive surgeries, and overall medical costs that were 5.3 percent lower than the control group.

Patient-centered care also emphasizes coordination among care providers, which creates better outcomes for patients with chronic health issues like my mother.

Converting to this model will take time, but re-evaluating how Medicare, Medicaid, and private insurance companies pay doctors can accelerate that process. Instead of paying for each patient visit or each lab test — the standard fee-for-service model most common today — insurance providers could receive a “care management fee” for each patient under their care and performance bonuses when a doctor’s patients show good health outcomes. This would mean that doctors get rewarded for promoting effective preventive treatments, not just expensive tests and surgeries. And it would reward doctors who coordinate care with other doctors to improve outcomes for their patients.

The ACA has piloted patient-centered care programs, including through Medicare and Medicaid, and they are showing major improvements in patient care. Unfortunately, though, programs like these are still limited in scope — and with Republicans in Congress now intent on dismantling the ACA limb-by-limb, we can’t count on their survival.

For example, one promising patient-centered care initiative isn’t being implemented in Florida, even though coordinated care is a major concern for the 20 percent of the state population that is over 65 years old. This should be troubling to anyone who’s ever worried about whether their health care is up to par.

So, as we approach elections this fall, it’s about time we broaden our conversation about health care. We need to be demanding that quality of care be on the agenda, preserving the reforms that have already started to show better patient outcomes, and insisting on legislation that expands efforts to give all Americans the kind of medical treatment they deserve. I started this conversation with my future constituents yesterday in a roundtable where I asked patients, community leaders, and health care providers to share their thoughts.

Not surprisingly, their real-world experience led them to ask two questions: “Can you make our care cheaper?” and also “Can you make it better, too?”


Lauren Baer is a Democratic candidate in Florida’s 18th Congressional District. She was a senior policy adviser to former U.S. Secretaries of State John Kerry and Hillary Clinton and to the U.S. Ambassador to the United Nations Samantha Power.

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