Health Affairs, 28, no. 5 (2009): 1316 doi: 10.1377/hlthaff.28.5.1316 © 2009 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

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Saving Money

PROLOGUE

Saving Money: What Works And What Doesn’t?

In the "yes" category, real-world examples are provided first by Arnold Milstein and Elizabeth Gilbertson, who describe four "medical home runs": California sites catering to chronically ill patients that, adjusted for risk, produce 15–20 percent lower per patient spending than the regional average. A core ingredient: primary care teams willing to go to "extraordinary" lengths to protect patients from preventable health crises.

Sticking with success, John Agwunobi and Paul London recount how Wal-Mart launched the $4 prescription, turning what once were retailers’ profits on selling generic drugs into savings for millions of Americans. Randall Krakauer and his Aetna colleagues take on end-of-life care and report how tighter coordination yields both savings and patient satisfaction. John Toussaint describes reengineering care processes at ThedaCare, a Wisconsin health system, that now has the lowest health costs in the state. Citing startling levels of health care fraud, meanwhile, Lewis Morris reports on the federal Health Care Fraud and Abuse Control program, which has so far recovered $17 in Medicare and Medicaid savings for every $1 expended.

In the "no" category, Michael Chernew and colleagues examine the assertion that producing more primary care doctors will help curb health spending growth. They turn thumbs down: although markets with more primary care doctors do spend less on health care at any given point in time, there’s no clear impact on growth rates.

Can we learn any lessons from abroad? That’s where the "maybe" comes in. Nicholas Timmins interviews Sir Michael Rawlins, head of England’s National Institute for Health and Clinical Excellence (NICE). Created in part to recommend whether the English and Welsh National Health Services should pay for new medical interventions, NICE conducts appraisals that assess costs in relation to extending patients’ "quality-adjusted life-years." Using a similar approach could benefit the United States, write Peter Neumann and Dan Greenberg—that is, if some U.S. lawmakers’ apparently political objections to taking cost into consideration could ever be overcome.

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