BOSTON — Alan Reiss has diabetes. His blood sugar is under control now, but “if I go back, maybe 18 months, I literally felt like I was dying,” Reiss said, shaking his head.
“I kept telling my friends that I was going to die early. I actually bought a life insurance policy ’cause I thought, well, I’m not going to live long so I might as well beat the odds for my wife.”
“Do you feel differently, having started the insulin?” asked Dr. Alan Cole, glancing up at Reiss from his computer screen.
The Wayland engineer is here because his diabetes pills weren’t working. Cole persuaded him to try the old fashioned but proven treatment, insulin shots. Reiss was reluctant.
“I had a fear of pain and all the inconvenience. I didn’t realize how easy it is and how painless it is,” Reiss said. “Now that I’ve been on insulin for a month or so, I feel normal. I actually feel healthy again.”
Reiss didn’t save any money by switching to insulin, but Partners HealthCare estimates all its patients with diabetes could save $3 million to $10 million a year by moving from expensive brand name pills to generics when effective, or from pills to insulin.
Partners itself does not expect to save any money in the short term by changing the way doctors treat what’s become an epidemic, diabetes. But in the long run, Partners and Reiss will save a lot if he and other patients stay healthy and avoid going to the hospital for related problems such as kidney, liver, eye or heart disease.
“I’ll have a longer life, I’ll have a better quality of life, and that’s really what I think the cost savings is, besides the cost of those pills,” Reiss said.
Thousands of Partners doctors and nurses will also have to adjust to this plan by counseling and coaching patients to use insulin and changing their prescriptions to favor generics.
“It’s an awfully big first phase. We’ve bitten off a huge amount here” said David Nathan, director of the Diabetes Center at Massachusetts General Hospital. Nathan is an international expert on the disease and is directing Partners’ new approach to diabetes.
“Some of the things that we’re talking about doing — limiting prescribing behavior among physicians — is something that we need to negotiate,” Nathan said. “This is complicated to coordinate because everyone takes care of someone with diabetes and there are tens of thousands of caregivers.”
Partners Unveils Care Redesign Plan
Diabetes is one of five conditions Partners is tackling in this first phase of its care redesign phase. (See a PowerPoint here.) For the second phase, heart conditions, Partners plans to improve follow-up care and avoid hospital re-admissions.
With stroke, Partners may create a center that would identify patients at risk. Colon cancer patients would move more quickly into standardized, laparoscopic surgery to reduce recovery time. Some of these changes may not sound dramatic, but they have helped other large health systems around the country control spending and improve care.
Partners is “paying tremendous and very important attention to the issue of how do we redesign care and improve it,” said Elliot Fisher, who directs the Center for Population Health at the Dartmouth Institute.
“That’s a separate question from what prices do we charge for those services, which is where I believe Partners has taken some heat in the recent past,” Fisher said. “Both are important if we’re going to solve the cost problem in the United States.”
Partners said this care redesign package will make care more affordable in the long run by keeping patients healthier. It’s also seen as a step that will prepare Partners to handle new payment arrangements, said Elizabeth Mort, senior medical director at Partners.
“No matter how that plays out, if we’re providing care that is higher value, that is better care at lower costs, we’ll be well situated to take care of our patients,” Mort said.
“So part of this whole redesign is to make sure we can be here for generations to come.”
The plan may lay the groundwork for Partners’ future, but some health care experts say we need to worry about the health of the whole health care system.
Critics Say More Is Needed To Transform Health Care In Mass.
“What Partners has proposed looks like a modest first step, a sensible thing to do, but will it transform the way health care is delivered in Massachusetts? No,” said Jon Gruber, a health economist at the Massachusetts Institute of Technology.
Gruber said there’s no point in criticizing Partners for taking modest voluntary steps, but “transforming the way health care is delivered in Massachusetts is going to mean creating losers, and no one likes creating losers in our political system,” he said.
Some consumer advocates say it’s time for Partners and other large, well-funded hospitals to absorb some losses. Nancy Turnbull, an associate dean at the Harvard School of Public Health, applauds Partners’ effort to improve care. But Turnbull said hospitals with significant reserves, including Partners, must use some of that money to lower prices now.
“We need to have a really serious conversation about the level of resources at all of these institutions and how many of these resources could be directed in the short term to deal with what I view as an affordability crisis that we’re facing right now,” Turnbull said.
A state report out last year showed Partners with $4 billion in reserves. Partners said much of that money is tied up in leases or investments or was donated for a specific project. CEO Gary Gottlieb says Partners is still in negotiations with health insurers, that began early this year, about reducing prices guaranteed in current contracts.
“If we’re able to succeed in those re-negotiations, that should bring money right back to employers and employees” Gottlieb said. “I don’t know many other businesses in which someone with an existing contract would go back and say, ‘Look, is there a way we can take less money in this,’ and that’s what we want to do.”
Gottlieb said Partners is on track to cut cost increases in half in two years. Employers, State House leaders and consumers are anxious to see that reduction translate into lower health insurance premiums.