Can competition and collaboration coexist in health care?

Consumer and Patient ResourcesAs a nation, we worship at the altar of capitalism. Our core belief? That competition results in increasingly better products and services at lower costs.

With today’s near monopolies in hospital systems, insurance behemoths and drug companies, we clearly need more competition in health care, right? An Ohio professor of health finance at Case Western Reserve University, J.B. Silvers, thinks we’re missing the point:

The big question is how physicians choose what care to recommend and provide and what results from their choices in terms of costs and outcomes. Since, by definition, the doctors know more about medical care than we do as consumers, it is difficult to believe that we can outguess them by selecting care alternatives in a competitive marketplace. We want them to know more and we are willing to pay them for this knowledge. So the real question is how can we change the way physicians practice to advance toward the triple aim of improved quality, better outcomes and reduced per capita cost?

Collaboration takes time

Doctors, of course, are on board with the goal. But keeping abreast of all sources of knowledge and collaborating with colleagues takes time, and most doctors don’t have it. Silvers touts the Better Health Partnership (BHP) in Northeast Ohio, on which he is a board member, as the way to go.

The nonprofit was formed in 2007 with a narrow focus: two Ohio counties, universal commitment of providers (more than 75 percent of primary care physicians), and an “integrator” taking responsibility for improved outcomes.

As the integrator, BHP performs many of the services doctors wish they had easy access to. With BHP’s help, participating physicians are exposed to shared data, best practices, demographic differences in treatment, and collaborative summits where top performers share how they did it. In other words, competitors are collaborating.

Collaboration produces results

The group tackled three medical conditions: diabetes, high blood pressure and congestive heart failure. New research in Health Affairs confirms BHP’s success after six years. Hospitalization rates in Cuyahoga County were down 22 percent. Residents experienced almost 6,000 fewer hospitalizations than would have been predicted, with a cost savings of $40 million.

We still need competition in health care, of course. But, as Professor Silvers observes, preventing unnecessary care and adopting the latest and best methods of care delivery requires that primary care physicians learn from each other. In a competitive marketplace, this type of collaboration doesn’t happen naturally.

We need to figure out how to foster both.

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