Improving Quality Will Reduce Costs

FORT LAUDERDALE, Fla--"The best way to reduce health care costis to improve health care quality," said Lee N. Newcomer, MD, MS,in his keynote address at the Second Annual Conference of the NationalCancer Center Network (NCCN). And managed care organizations are attemptingto do this via measuring and improving the performance of physicians inits networks, he added.

Dr. Newcomer is chief medical officer of United Healthcare, a managedcare provider based in Minneapolis.

Measurable performance data are the only means to demonstrate valueobjectively, he said, and the ability to demonstrate value is what distinguishesone physician and one hospital from another.

"The people who run managed care organizations are looking forphysicians and hospitals that will add value," he said, "We wantto know what's different about what you do so that I can say we shouldhave you in this network rather than the physician down the street."

Managed care organizations seek value from their network physiciansand hospitals, and work to offer the same in return, he said.

United Healthcare, for example, does more than just pay claims. It addsvalue to its network physicians and hospitals by improving quality to reducecost, developing information systems to identify quality issues, and sharingthat information with providers and hospitals.

He also suggested three ways oncolo-gists can add value to their services:

Act as the patient's personal care physician. Managed care organizationsare finding that "the type of treatment you get is directly relatedto which doctor you see first," he said. "If you are dealingwith a cancer that has three options, you will likely get surgery if yousee a surgeon, radiation if you see a radiation oncologist, and chemotherapyif you see the oncologist." He believes that oncologists must remainthe general consultant for oncology, and direct when to treat, how to treat,and when to offer supportive and palliative or hospice care.

Additionally, he said, "you have to make chemotherapy a cost-neutralequation, by avoiding excessive markups for medications. The industry isprobably going to do this for you."

Measure your performance. "Performance measurement is critical,"he said. Although data collection is not simple and yields no financialreward, "I think it is your key to staying in business even two tofive years from now."

Improve your performance and document those improvements. Thepoint of measuring a physician's performance is not to criticize it butrather to help the physician improve, he said. Managed care organizationswill be generating practice data for their physicians, but physicians shouldalso generate their own data.

"Not only will measuring your performance provide you with objectivedata, it will improve your skills as a physician, enabling you to go froma good physician to a superb physician," he said.

He emphasized that physicians and hospitals can demonstrate their valueby documenting quality performance that may lead to improved care and reducedcost, and showing that data to managed care organizations.

Reducing cost by improving quality includes eliminating waste and reducingvariation, he said. For example, approximately $90,000 was billed to UnitedHealthcare in 1996 for tine tests for tuberculosis in children even thoughthree years earlier, the American Academy of Pediatrics issued a policystatement that such tests were ineffective in children.

Dr. Newcomer believes that sharing such findings with providers andhospitals will enable clinicians to evaluate the evidence, look at theirown performance, and, if necessary, improve their practice to comply withevidence-based standards of care, while also helping to lower costs.

Micromanagement Not the Aim

Dr. Newcomer stressed that managed care plans do not want to micromanagephysicians' practices, but rather provide standards ("and it may bethe NCCN guidelines," he said) for physicians to follow in a way thatworks best for them.

The plan, he said, will set the standards and set the rewards for meetingthose standards, "then get out of the way, so that you can achievethose standards in your own way. That's what we call 'accountable autonomy.'"

The NCCN guidelines are a good beginning toward establishing evidence-basedstandards, Dr. Newcomer said, adding that any guideline is only a recommendationand does not replace good clinical judgment. "Each physician needsto take responsibility for his or her own performance," he concluded."That is, know the standards, use them wisely, and measure your ownperformance against established standards."