So- Which Way Do We Want It?

The February 9, 2010 Wall Street Journal reported that United HealthGroup recently began sending doctors individualized assessments for their treatment of breast, lung, and colorectal cancer patients. The reports seemed to indicate that while breast cancer patients received care that met with most professional protocols, patients with lung and colorectal cancer did not.

Treating cancer patients is one of the largest cost-drivers in our health care system today. Employers will confirm that one or two cancer patient in their entire population can result in significant increases to the health insurance rates for everyone. That’s the problem with the system we have today.

The United HealthGroup initiative confirmed what many of us had already surmised- a lot of the prescriptions and processes used in cancer treatment may or may not be of benefit to the patient, and they cost a lot of money.

Health plans and health systems are spending a lot of time and resources to determine what works best for treating particular conditions. They’ve been doing it for years. Most health plans are including “pay-for-performance” components to try to incent the delivery system to follow protocols, engage in electronic technologies, and improve the care delivery of the patient. Comparative effectiveness is alive and well in the health plan system. Those that deliver the care don’t like it- but it’s the way they get paid today.

A few months ago the U.S. Preventive Service Task Force produced their own results concerning the use of mammograms for breast cancer detection in females. This body was established in 1984 of independent private sector experts in prevention and primary care delivery. When they produced their results indicating it is really statistically necessary for an annual mammogram beginning at the age of 50 instead of 40 a huge hue and cry was raised from the masses as an example of government’s intrusion into our health, our health care, and our way of life. This was the perfect example of “Death Panel Health Care” with the politicians.

In order to get a handle on the costs of this uncontrolled system we have today we need to know what works, what doesn’t work, and what works sometimes. We also need to know what it costs. Call it comparative effectiveness, protocols, evidence-based, or whatever you want there are simply too many options, technologies, and pharmaceuticals, to continue the path we’re on today. The system needs some guidance and direction.

The health plans are already providing most of the direction. The system as a whole needs to decide whether it needs some other options to consider as well. And we need to quit complaining when results are published that don’t necessarily agree with the way things have always been.

The way things have been is what got us into this mess in the first place