By Sally Voth firstname.lastname@example.org
Three hundred guests dining at the Museum of the Shenandoah Valley Business Forum Luncheon on Tuesday had a lot to digest.
Susan Dentzer, editor-in-chief of the journal Health Affairs, spent more than an hour presenting her reasons why the Affordable Care Act was necessary, and its merits.
"It's hard to conjure up an issue in American politics that has really elicited so much divisiveness among the parties," she said. "What we might be able to agree on, however, are those things inherent in what we call the triple aim."
The triple aim is to strive for better health, better health care and lower costs, Dentzer said.
"That's it," she said. "We just have to pursue that agenda."
Individuals' health is impacted by a variety of factors, according to Dentzer's presentation. These include obesity, lack of exercise, smoking, stress and aging. There are other contributors to early death, such as genetics, social factors and a lack of health insurance.
The latter leads to the premature death of 18,000 Americans annually, Dentzer said. She said that's about half the number of women who die of breast cancer each year.
According to a RAND study from 2003, patients received recommended health care about 55 percent of the time, Dentzer said.
"Basically, it was almost a coin toss whether we get recommended care," she said. "We also have another very troubling issue, which is do we know what works in health care? More than half of the treatments that we deliver in the U.S. health care system do not have clear evidence of effectiveness. That's an awful lot of health care that is being provided without people understanding whether it works or it does not."
The questionable efficacy came out of a 2009 Institute of Medicine report, according to Dentzer.
"Health Affairs" published a comprehensive report on patient safety in 2011 that revealed troubling conditions at hospitals. Dentzer said three of the most sophisticated academic health centers in the hospital were reviewed.
"They concluded for one of out every three admissions, an adverse event had occurred," she said.
The most serious were medicine and surgical errors - wrong dosage, wrong patient, wrong body part operated on. Operations were performed on the wrong part of the body 40 times a week in the U.S., according to Dentzer.
And, she said, The Centers for Disease Control and Prevention estimates one out of 20 patients in the hospital acquires an infection there.
"These are really serious issues that we contend with every day," Dentzer said.
She also said that while most people would rather die at home, more than two-thirds of those admitted to the hospital in the last month of life died in the hospital.
"We know that most of the costs in the health care system are basically tied up in care of the sickest patients," Dentzer said. "Our big goal now is to try to take people that have the early stages of chronic illness and keep them from getting worse. We know that we have a lot of waste in the health care system. We have over-treatment, subject patients to care that can't possibly help them."
One provision of the health care law that has already been implemented - allowing young adults to stay on their parents' health insurance policies up to age 26 - means 3 million more people are covered, said Dentzer, who is on the Kaiser Commission on Medicaid and the Uninsured.
She said the health care industry needs to move from an old model that rewards unit costs and requires payment for unproven services to a new one rewarding outcomes, lowering costs and improving quality, safety and evidence.
There are two unknowns ahead, according to Dentzer: who will win the presidential election and will the country move ahead with Medicaid expansion and insurance exchanges.
Valley Health sponsored Tuesday's luncheon, and CEO Mark H. Merrill was in attendance. After the forum, he said he thought Dentzer's presentation was very thorough and accurate, and the triple-aim approach is what health care reform is striving toward. That approach includes lifestyle choices that improve health, he said.
Free Medical Clinic of the Northern Shenandoah Valley Executive Director Vicki McClelland said the presentation confirmed "information that we've known over the years."
"I think the question still is who will in the state of Virginia be able to support the uninsured low income depending on what happens with Medicaid," she said. "We're still going to have a focus on access to care, whether it be with a provider shortage in the future, or access to Medicaid, or access to health care for Virginians that are low income and do not qualify for the new insurance exchanges...We can't do it without our community's support, though."