from common misperceptions to new realities · from common misperceptions to new realities charles...

From Common Misperceptions to

New RealitiesCharles W. Sorenson, MD

President Emeritus, Intermountain Healthcare, and Founding Director, Intermountain Healthcare

Leadership Institute

Misperception

What matters most to healthcare is who gets elected

Reality

There is no scenario where raising quality and lowering costs isn’t the winning strategy

Misperception1

Quality costs more

Cost and Quality

are inseparably linked

Reality1

Quality lowers total cost of care

Elective Inductions < 39 Weeks

Timing of Elective Inductions

0%

5%

10%

15%

20%

25%

30%

35%

0.00%

0.25%

0.50%

0.75%

1.00%

1.25%

37th Week 38th Week 39th Week

1.12%

0.45%

0.21%

Perc

ent

on

ven

tila

tor

Increased risk of newborns on ventilators with inductions < 39 weeks

Timing of Elective Inductions

0%

5%

10%

15%

20%

25%

30%

35%

Over $1.7 million in savings during 2009 and 2010

Elective Inductions < 39 Weeks

Timing of Elective Inductions

• Nuclear Stress Testing

• Angioplasty and Stents (PCI)

• Implantation of Permanent Pacemakers

• Implantation of Defibrillators

Clinical Outcomes: • Remained ExcellentAnnual Costs to Community: • Decreased by $15 million as compared to

expected volume-adjusted charges

Source: Clinical Program

Evidence-based cardiac interventions

Misperception2

High-tech always means better care

Reality2

Expensive devices and pharmaceuticals don’t always produce better outcomes

Gizmo Idolatry

1. Common sense appeal

2. Human love of bells and whistles

3. Exploits vs. uneventful diligence

4. Proof of competence

5. Proof against negligence

6. Channeling money

1Leff, B and Finucane, T. JAMA 299:15 (April 2008)Illustration © Scientific American

Misperception3

Every patient wants any treatment that might possibly help

Reality3

Fully informed patients make good choices that are right for them

Misperception4

Physicians shouldn’t be concerned about the cost of treatment

Reality4

Protecting our patients’ resources is part of taking care of them

Misperception5

Population health = rationing

Reality5

Population-based payment allows us to invest in keeping patients healthy

Misperception6

Transparency in healthcare is too flawed to be useful

Reality6

Transparency is inevitable and has the potential to be very useful

TURP Study

Misperception7

It’s impossible for people to change their behavior

Reality7

People can change their behavior with the right motivation

We can change health behaviors

TEENPREGNANCY

Cut 50% since 1991

SEATBELT USE

14% in 198485% in 2012

HIGH LDLCHOLESTEROL

59% in 197627% in 2010

45% of all adults in 196518% in 2014

ADULTSMOKING

Photo credit: iStock Photos Source: www.cdc.gov/nchs/data/databriefs/db117.htm

TEEN ALCOHOL,DRUG, TOBACCO

Trending down since 2002

DRUNK DRIVING DEATHS

Cut 50% since 1982

Misperception8

Healthcare (physicians) exist to fix problems

Reality8

We exist to create health and fix problems when needed

Misperception9

Doing well financially means doing more stuff

Reality9

Doing well will mean doing the right stuff

Misperception10

The future of healthcare is bleak

Reality

We have never had greater potential to create a bright future

10

“I am sorry for you, young men

(and women) of this generation. You will do great things. You will have great

victories, and standing on our shoulders,

you will see far, but you can never have our sensations. To have lived through a revolution, to have seen a new birth of science, a new dispensation of health . . . a new outlook for humanity, is not given to every generation.”

- William Osler

“I am sorry for you, young men

(and women) of this generation. You will do great things. You will have great

victories, and standing on our shoulders,

you will see far, but you can never have our sensations. To have lived through a revolution, to have seen a new birth of science, a new dispensation of health . . . a new outlook for humanity, is not given to every generation.”

- William Osler

“I am sorry for you, young men

(and women) of this generation. You will do great things. You will have great

victories, and standing on our shoulders,

you will see far, but you can never have our sensations. To have lived through a revolution, to have seen a new birth of science, a new dispensation of health . . . a new outlook for humanity, is not given to every generation.”

- William Osler