Changing Health Care from the Front Lines

By Joanne Conroy, MD

There are hundreds of books published every year that make contributions to our collective knowledge, but very few of them create real impact. Many stop at the first step on the continuum that ranges from acquiring knowledge, understanding what to do with that knowledge to solve problems, and successfully implementing solutions. A new book can move engaged providers, patients, and policy makers through that important evolution.

Three medical students, Chris Moriates, Vineet Arora, and Neel Shah, met via social media and found that they shared an interest in bringing information about the costs of care into the medical decision making process. They noted that most of the discussion in medical training is about what policy makers and insurance companies should do about health care costs. They acknowledged an emerging focus on how patients should adjusts as more people shift to high-deductible insurance plans that make them increasingly accountable for out-of-pocket costs. But they could not find, in the current learning environment, much discussion about the role of physicians delivering care that is sensitive to costs.

The three young physicians started a group to elevate and expand the conversation among medical students and residents about the costs of care. When they met, the organization was more like a club  where people brainstormed and eagerly shared ideas. With the support of the ABIM Foundation, they brought in expertise to help them incorporate as a legal nonprofit organization, Costs of Care. This is where I met Neel. While a resident at Brigham and Women’s Hospital in Boston, he did a presentation on the costs of care at a meeting in Massachusetts. Unlike others, who were analyzing the landscape, Neel was trying to change the landscape. His passion and commitment to delivering value was a breath of fresh air. I met Vineet soon after, and marveled at the incredible devotion they had to their common cause in very busy lives.

Costs of Care produced several instructional videos to show residents and medical students how to introduce questions about cost into the educational model. Their ultimate goal was authoring a book that could serve as an introduction to “value-based care.” They wanted to clearly communicate how our failure to improve price transparency, measure value, address disparities, and invest in primary care has resulted in the U.S. health care system falling short in may critical areas. Last week, the publication of that book was celebrated at an event in Boston that I had the privilege to attend.

It was great to see the culmination of more than five years of work the trio began as students. They are now respected professionals at Beth Israel Deaconess (Shah), the University of Chicago (Arora), and the University of California at San Francisco (Moriates).

The launch party was attended by many of the like-minded. Such industry leaders as Mark Kelly, formerly of Henry Ford Health System, and Rich Baron, CEO of the ABIM, were there to cheer them on.  Wonderful remarks were delivered by their publisher, who noted that while his company publishes many books, but he was especially thrilled to work with Neel, Vinnie, and Chris because their work will  have a real and lasting impact on health care.

So how do we continue to move this initiative forward?

  • Work to get this book into the hands of every medical student and resident in the United States
  • Give this book to your hospital board members
  • Give the book to your siblings and create great debate over family holiday dinners on what this means for the average American
  • Measure your own organization’s performance against the tenets of the book (note to self: see if an elegant evaluation tool can be developed to connect to the Costs of Care website). Lahey Health is one of the handful of low-cost providers in Massachusetts, but I am sure we could be more efficient.
  • Read and participate in discussions on social media discussions. These become dynamic environments in which to continue the conversation.

Within the health care industry, we should remove things that do not deliver value, are not aligned with our vision for health care, and do not improve the quality of outcome or the patient experience. Begin the self-examination within your organization.

These three young physicians are living their lives with a purpose and for a purpose: to provide tools and strategies for all of us to improve American health care within a sustainable cost structure. Buy the book today.

Joanne headshot_2014Joanne Conroy, MD, is chief executive officer of Lahey Hospital & Medical Center in Burlington, Massachusetts. She can be reached at joanne.conroy@lahey.org.

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