Like many who have long toiled the oft-barren fields of change in health care, dismal numbers rarely shock me – But earlier this week, at the IHA’s P4P Summit, Jill Yegian showed us a slide that hit me hard. It comes from last year’s report by the Commonwealth Fund on State’s Health System Performance, and shows the difference in mortality amenable to health care by race. The upshot is that the national average is 86 per 100,000 people for whites, and twice that number for others. In some states it’s less than half, and in other states it's a lot more. Shockingly more. States that are usually recognized for excellence in care and leading edge change, like Wisconsin or Minnesota, are in the “more than twice” category. Granted, overall, their performance is better, but the disparity is as large as or greater than other States such as West Virginia. It begs the question, which was answered to an extent in a new report by Jeff Goldsmith, Rob Burns and colleagues, as to what type of societal or other benefit has been produced by the integrated health networks that pepper those States. The answer, in a nutshell, is not much.
What this means to you – On the home page of our web site, we have a dashboard of metrics. We built the dashboard a little like a pyramid of values. At the top sit two main indices, one on affordability, and one on quality. The metric for quality that we selected a few years ago is the number of excedent deaths that occur in the US due to deficiencies in the health care system. While that might seem odd because, as a small organization, we likely have very little ability to impact that number, it stands as our moral compass. With every day that passes, more deaths get added to the metric, and we ask ourselves: What are we going to do today to make the counter slow down? Not what can we do, but what will we do. If every health system and every State Department of Health had this counter, split into sub-components for every race, popping up on their screen every morning, perhaps they would also ask themselves the same question. Jeff and Rob’s report reminds us that many of these health systems, who are busy with the business of health care – buying practices, buying other facilities – have forgotten the mission of saving lives, or have tilted it towards a certain category of patients. And frankly it’s almost inevitable when the “organization” becomes the focal point of policy and care as opposed to the patient. We have to stop pretending that artificially aggregating patients around a health care organization, whatever acronym it bears, will magically solve the problems this slide illustrates. These numbers aren’t just shocking, they should make all of us sick to our stomachs. And hopefully a few more will resolve to permanently eliminate these shameful gaps.