Economist Challenges Governor Kitzhaber to Make Evidence-Based Practice the Standard of Care
OPINION – May 8, 2012 -- Regence's recently announced decision to drop contracts with certain provider networks used by individual policyholders in the Portland area is an ominous and dangerous development. Not only does it challenge the single thing most healthcare consumers think is best about the current payment system -- wide choice and dependable coverage of one's personal caregivers- it is inexplicable as a first line of response to the problem of costs.
A far more auspicious tool would involve fundamental provider reimbursement reform. Key among the components of such a package should be the use of "evidence-based practice" as the default standard of care for purposes of payment. Right now, Regence and other insurance carriers throw hundreds of millions of dollars at medical services that are not backed by hard scientific evidence even where evidence-based practices are available and could reduce costs and increase quality.
Although evidence-based practice has been well recognized in the medical field for years, it is still severely under-used, especially in the private insurance sector. To gain real traction, it needs a champion in the right place and maybe also a triggering event like a threat to access and to the continuity of the
doctor-patient relationship. Governor Kitzhaber should come forward as that champion. His professional background and commitment to evidence-based practice is unquestioned.
The Governor's first effort should be to task the State Insurance Division
to make evidence-based practice the standard of care for reimbursement in the private insurance market. The Division now has the funding and actuarial capacity to take on this kind of job, courtesy of federal grants under the Affordable Care Act. Evidence- based practice is where the savings and quality improvement opportunities can be found. Why threaten access and disrupt practice relationships before fully exploring potentially more productive avenues?
Larry Kirsch is a health economist and managing partner of IMR Health
Economics. He has served as an expert witness in health insurance rate
review cases throughout the country.