Closing the knowledge gap

Opinion: April 8, 2011 at 12:00a.m.

By Pete Lawyer and Stefan Larsson

McClatchy-Tribune

Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, sailed into hostile waters recently when he testified before a congressional committee on the Patient Protection and Affordable Care Act.

Called ostensibly to pose questions about the act, the hearings saw Berwick running the gauntlet as the new Republican majority fired broadsides at President Obama’s signature legislation.

True, there are many reasons for concern. The 2,000-page bill rushed through Congress last year includes the germs of so many new government agencies and activities no one has a good handle on future consequences. But some provisions of the act clearly offer tangible benefits.

Ironically, the “Patient Centered Outcomes Research Initiative” — held up by some as evidence of future government “death panels” — may be among the most beneficial.

Handled with integrity and led by the relevant medical specialists, comparative effectiveness research focuses on patient outcomes — the most important unit of measurement — and offers the chance for real strides in quality of care. This, in turn, can reduce costs.

Outcomes measures can be very simple, such as 30-day or one-year mortality following a heart attack. Their clarity and prevalence as health statistics permits comparisons over time and across geographic boundaries.

Health-care value

This is the real promise of health-care reform: a system in which health-care value is determined by patient outcomes divided by cost of care.

This simple equation was put forward by Harvard Business School professor Michael Porter and co-author Elizabeth Olmsted Teisberg of the University of Virginia’s Darden School in their 2006 book, “Redefining Health Care.”

Critics howled that to contemplate such a system was naive and unworkable, since the required data don’t exist. The solution to this is not to throw out a concept that might finally permit a market-based solution to rising health costs. Rather, the solution is to harness the remarkable advances in technology and connectivity of the last decade to ensure that secure and reliable data are freely available.

Consider Sweden’s disease registries, which provide high-quality patient outcomes data for approximately 70 medical conditions representing about 25 percent of Sweden’s total health-care expenditures. In some cases, the registries carry longitudinal data for several decades; in all cases, the relevant medical specialty groups have taken the lead in developing and keeping the registries up to date.

The Boston Consulting Group has worked with Swedish business leaders, government officials, academics and specialist groups to understand how the registries have affected health care treatment and costs. In the wake of that work, Sweden has boosted funding for the registries approximately threefold.

Cataract surgeries

Consider a single example for a common surgical procedure: cataract surgery. Most cataract surgeries come off without a hitch, but every so often there is a rare complication known as postoperative endophthalmitis, which leaves many of its victims with limited vision or blind. While the incidence of POE is tiny, medical researchers needed very large numbers to solve the problem.

Fortunately, Sweden’s National Cataract Register tracks nearly 100 percent of the 80,000 or so patients who undergo cataract surgery each year. This enabled Swedish ophthalmologists to prove that prophylactic antibiotics reduce the incidence of POE. As a result of this and other observations, the incidence of POE dropped by a factor of five from 1998 to 2009.

Sweden offers the most complete set of registries in the world, but well-run registries can be found all over. The Cystic Fibrosis registry, for instance, founded in 1966, now covers virtually all CF patients in the United States. Likewise, the U.S.-based Surveillance, Epidemiology and End Results registry tracks cancer patterns for approximately 28 percent of the U.S. population and holds data on a staggering 6 million patients.

While the health-care reform battle continues on Capitol Hill and in the courts, perhaps conservatives and liberals should consider a truce on one aspect of the plan that should be obvious: the need for better information on patient outcomes.

Better outcomes after all are what everyone wants.

Pete Lawyer is a senior partner in the Minneapolis office of The Boston Consulting Group. Stefan Larsson is a senior partner in BCG’s Stockholm office. Distributed by McClatchy-Tribune.