{"cache":{"posts_f30bc_ef1c5":{"__typename":"RootQueryToPostConnection","nodes":[{"__typename":"Post","id":"cG9zdDoxNDEyMQ==","databaseId":14121,"featuredImage":null,"author":null,"date":"2012-06-28T17:00:43","uri":"/articles/health-care-costs-and-reform","title_b28e9_bf21a":"Health Care Costs and Reform","slug":"health-care-costs-and-reform","categories_3cd3e_bf21a":{"__typename":"PostToCategoryConnection","edges":[{"__typename":"PostToCategoryConnectionEdge","node":{"__typename":"Category","id":"dGVybToxNTQx","name":"Health + Traits","slug":"health-traits","uri":"/category/health-traits","seo":{"__typename":"TaxonomySEO","title":"Research Archives - 23andMe Blog","opengraphTitle":"Research Archives","metaDesc":"23andMe research unique research model combines genetic and phenotypic information in what is among the largest databases of its kind.","opengraphDescription":"23andMe research unique research model combines genetic and phenotypic information in what is among the largest databases of its kind.","fullHead":"\n\n\n\n\n\n\n\n\n\n\t\n\t\n\t\n\n\n\n"}}}]},"imageOptions":{"__typename":"Post_Imageoptions","featuredImageSquare":{"__typename":"MediaItem","id":"cG9zdDoxMTk4NA==","mediaDetails":{"__typename":"MediaDetails","sizes_cad4b_bf21a":[{"__typename":"MediaSize","name":"thumbnail","sourceUrl":"https://blog-api.23andme.com/wp-content/uploads/2012/03/robert_pearl1-150x150.jpg"},{"__typename":"MediaSize","name":"medium","sourceUrl":"https://blog-api.23andme.com/wp-content/uploads/2012/03/robert_pearl1-300x290.jpg"},{"__typename":"MediaSize","name":"square_sm","sourceUrl":"https://blog-api.23andme.com/wp-content/uploads/2012/03/robert_pearl1-271x271.jpg"},{"__typename":"MediaSize","name":"square_md","sourceUrl":"https://blog-api.23andme.com/wp-content/uploads/2012/03/robert_pearl1-372x372.jpg"},{"__typename":"MediaSize","name":"wide_sm","sourceUrl":"https://blog-api.23andme.com/wp-content/uploads/2012/03/robert_pearl1-271x149.jpg"},{"__typename":"MediaSize","name":"wide_md","sourceUrl":"https://blog-api.23andme.com/wp-content/uploads/2012/03/robert_pearl1-372x204.jpg"},{"__typename":"MediaSize","name":"wide_lg","sourceUrl":"https://blog-api.23andme.com/wp-content/uploads/2012/03/robert_pearl1-488x315.jpg"}],"height":472,"width":488},"mediaItemUrl":"https://blog-api.23andme.com/wp-content/uploads/2012/03/robert_pearl1.jpg","sourceUrl_772ce_bf21a":"https://blog-api.23andme.com/wp-content/uploads/2012/03/robert_pearl1.jpg"}}},{"__typename":"Post","id":"cG9zdDoxMTk3OA==","categories_3cd3e_bf21a":{"__typename":"PostToCategoryConnection","edges":[{"__typename":"PostToCategoryConnectionEdge","node":{"__typename":"Category","id":"dGVybToxNTQx","name":"Health + Traits","slug":"health-traits","uri":"/category/health-traits","seo":{"__typename":"TaxonomySEO","title":"Research Archives - 23andMe Blog","opengraphTitle":"Research Archives","metaDesc":"23andMe research unique research model combines genetic and phenotypic information in what is among the largest databases of its kind.","opengraphDescription":"23andMe research unique research model combines genetic and phenotypic information in what is among the largest databases of its kind.","fullHead":"\n\n\n\n\n\n\n\n\n\n\t\n\t\n\t\n\n\n\n"}}},{"__typename":"PostToCategoryConnectionEdge","node":{"__typename":"Category","id":"dGVybTo5","name":"News","uri":"/category/news","seo":{"__typename":"TaxonomySEO","title":"Research Archives - 23andMe Blog","opengraphTitle":"Research Archives","metaDesc":"23andMe research unique research model combines genetic and phenotypic information in what is among the largest databases of its kind.","opengraphDescription":"23andMe research unique research model combines genetic and phenotypic information in what is among the largest databases of its kind.","fullHead":"\n\n\n\n\n\n\n\n\n\n\t\n\t\n\t\n\n\n\n"},"slug":"news"}}]},"uri":"/articles/spending-less-and-improving-health-care","content_b28e9_bf21a":"

In the lead up to this week’s arguments at the Supreme Court over the health care reform law, 23andMe got the opinion of two doctors on what’s ailing the country’s medical system.

On separate visits we heard from Bob Kocher, an MD and partner at Venrock who previously served as a special assistant to the president for Healthcare and Economic Policy and was instrumental in writing the reform law. A few weeks after hearing from Kocher we heard from Robert Pearl, also an MD and the Executive Director and CEO of The Kaiser Permanente Medical Group. Under Pearl’s leadership Kaiser has been singled out as an example of how to deliver quality affordable health.

$\"\"$ Robert Pearl, MD

While Kocher’s and Pearl’s opinions on the law and whether the court will uphold it diverged on some points, both men offered a pretty grim diagnosis if some sort of reform doesn’t go forward. Spending on health care continues to grow more rapidly than the economy as a whole. We now spend about 18 percent of our GDP on health care or – a larger share than what we spend on manufacturing or retail trade. Back in the early 1960s health care costs were only about 4 percent of GDP. According to Pearl, the rapidly growing costs are on course to cripple the economy.

The irony about all this spending is that while we pay out far more than any other country in the world and more than twice the average for industrialized countries, our outcomes are worse. We have lower life expectancy and higher infant mortality rates than countries that spend far less.

Under the current system there aren’t incentives for preventing diseases. All the upside is in treatment or interventions and this drives costs up.

“People have a hard time understanding that we are able to spend less and improve quality,” said Pearl.

He touted Kaiser – the largest medical group in the nation – as a model for better care at less cost.

“If every American got the same care (as they do at Kaiser) there would be 200,000 fewer strokes each year, 75,000 people wouldn’t die of cancer and the mortality rate of AIDS/HIV would be halved; sepsis in hospitals would diminish by 40 percent,” Pearl said.

Some of this is done through better use of data, integrating treatment and preventative care and effectively using technology. He pointed out that in many ways medical care is still a cottage industry in America with doctors providing “piecemeal” services isolated from each other. And he said the system is largely out of touch with the economic efficiencies and technologies we see in other sectors, like banking. He foresees simple fixes such as the widespread use of electronic records similar to the system used by Kaiser, as well as video-links for some types of doctors visits and the use of more email exchanges between doctors and patients. All these can reduce costs and improve efficiency, he said.

Much of this is in line with Kocher’s prescription for reform.

$\"\"$ Bob Kocher, MD

Back in 2009, Kocher and several others authored a report for the Brookings Institute, called “Bending the Cost Curve,” that outlined in detail several strategies for reducing the growth of health care costs. Many of these ideas were incorporated into the health care reform bill.

He outlined for us some of the things he felt were key components of those strategies, foremost of which was moving away from paying by treatments toward a system that bundled payments. For example instead of compensating a hospital for all the different treatments they delivered to a diabetes patient in a year, the hospital would be paid one lump sum for treating everything related to that patient’s care in a year while meeting certain quality metrics.

Both Kocher and Pearl also talked about giving patients access to more information to involve them in their own health decisions and empower them to make choices. Kocher mentioned that giving people more information about the costs and performance of doctors and hospitals empowers them to be better consumers. They’ll know which doctors and hospitals have better outcomes and this will help them make smarter decisions when choosing where they spend their health care dollars. This is also the premise behind the company Castlight Health, where Kocher is on the board of directors.

Both Kocher and Pearl believe that genetics tests like 23andMe’s will play a role in making health care more personal and they believe that the tests will become increasingly more commonplace. But, as Pearl said, there is a long delay in the adoption of new technology within the health care industry. There is also a lot of negative inertia within the system in which the rewards are for treatment not for prevention.

23andMe CEO and co-founder Anne Wojcicki recently wrote about this explaining:

“If I develop type 2 diabetes, the whole healthcare system knows how to deal with it, treat and profit from it. But if I discover I am at high risk for type 2 diabetes, I change my diet and exercise patterns and successfully prevent it, no one profits but me. We believe that engaging people in their own health care by giving people access to their genetic information and informing them of how to prevent disease can help.”

While all the attention this week is on the legal questions being argued in front of the Supreme Court, this broader question about how best to lower costs, improve quality and empower people in their own health care isn’t going to go away any time soon.

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$\"\"$

As science types, we’re often mystified – and maybe just a little exasperated – by the details of health care policy. But 23andMe director Esther Dyson has a very interesting post on the blog of the policy journal Health Affairs that we recommend.

It’s very interesting to hear what Esther, a person who often seems to be thinking a few steps ahead of the rest of us, has to say about what will happen as consumers take a more active role in their own health care:

\n
Years ago, Intuit’s Quicken let people manage a checkbook online and print out checks. As the world moved online, Intuit built interfaces to the online banking services of certain major banks so that users could upload and download their financial information. Pretty soon after that, the less-popular banks built their own interfaces to Quicken in order to capture or regain market share. None of them really wanted to let users mingle data from one source with data from another . . . but of course it happened. And now, users can use Mint or Wesabe [a company that Esther invests in] not just to mingle data but to analyze it, to compare their own spending patterns with others’ and (here’s the business model) to receive “offers” from other financial institutions based on those spending patterns.
\n
I expect exactly the same thing to happen with health information. And, just as banks compete (mostly with success) to keep customers’ money and data safe, so will the organizations that handle users’ medical information. This doesn’t actually require any legislation or standards to happen. Companies are already emerging that will provide interfaces to the IT systems of market-leading health care and insurance providers; eventually, the laggards will adapt to the market standards set by the leaders.
\n

Once those standards are in place, Esther predicts that our health care system will benefit greatly from the availability of all that data. For one thing, the availability of data will enable research that leads to better treatment. But perhaps most provocative is the prospect that health providers could be rewarded not just for going through the motions, but actually improving their patients’ lives.

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health care reform

Health Care Costs and Reform

Spending Less and Improving Health Care

Patients are Consumers: Esther Dyson on the Evolution of Health Care IT

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