Is the U.S. voter prepared to pay $2,400 per year for health care expenses? Are corporate shareholders and pension funds willing to cut in half pretax earnings to balance rising health benefits costs? Is American society braced for health care to climb to a $4 trillion expense by 2013 and consume 20 percent of the country’s Gross Domestic Product?

Clearly, the U.S. health care system is a perfect storm, as evidenced by double-digit cost increases; poor quality and compromised safety; disparities between those with insurance and the 47 million lacking it; work force shortages; technology races; declining margins and eroding solvency; weakening provider morale; increasing barriers and risks to market entry for innovators in biotechnology, drug and device sectors; and increased public discontent with overall performance. It’s a mess. It’s nearing meltdown.

U.S. health care’s considerable accomplishments in many circles are outweighed by its systemic problems, particularly those around quality, cost and access. Solving these problems requires a public and private collaboration that is supportive of five transformational changes: 

• Improve quality by applying available evidence to deliver safe and effective care. Emphasize error avoidance in tandem with adherence to evidence-based practice to reduce errors and remove inappropriate variation, inefficiency and suboptimal outcomes; promote more efficient integration of clinical interventions in practice; narrow the gap between science and practice. As much as 30 percent of health care costs is the result of misuse and overuse of system resources.
• Leverage information technology to reduce errors, improve clinical outcomes and improve coordination of care. Promote the convergence of clinical, financial and operational information to reduce paperwork, redundancies and avoidable costs; facilitate in-home, in-office and in-hospital information sharing via community-based networks such as Health Information Exchanges.
• Reduce demand by focusing on chronic and preventive care; strengthening coordination of care and primary care services; and facilitating personal accountability via tools to achieve guided self-care management. Better coordination of care can reduce avoidable problems.
• Change incentives from volume- and consumption-driven to outcome- and performance-driven. This requires a shift to value-based purchasing.  
• Engage consumers to change the way they look at the system and to transition from nonparticipatory “patients” to actively participating “consumers” of health care. Consumers need to be able to navigate the system appropriately, make judgments about their own care and know what costs are. This can be accomplished by encouraging increased transparency, the use of self-care tools and individual purchasing responsibility

When implemented, these transformational changes can provide funding for innovation and a safety net for those who can ill-afford or lack eligibility for insurance. They accommodate the need for coverage for the uninsured. They improve care and reduce costs. In total, they constitute a comprehensive platform for curing the U.S. health care system. Subtracting any single initiative substantially limits the likelihood for transformational success.

The Deloitte Center for Health Solutions, part of Deloitte LLP, offers thoughtful insight and analysis about the problems facing the U.S. health care industry. Our goal is to stimulate meaningful discussions among all stakeholders and to serve as a springboard for developing workable solutions to address the nation’s health care challenges. The five transformational changes outlined above constitute a platform that is built upon public and private collaboration. It is our hope that, with all parties working together, the United States will be able to cure its health care ills.

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Overview: Center for Health Care Solutions