Focus on Lower Cost

June 12, 2018

Achieving the Quadruple Aim

By Joseph Frolkis MD, PhD, FACP, FAHA

President and Chief Executive Officer, New England Quality Care Alliance


Joe Frolkis

For this third installment in my series on achieving the Quadruple Aim, I’ve chosen to focus on reducing cost. To begin, it’s important to address what is often the reflex response of those of us who went into medicine to take care of patients – “I’m not a bean-counter, and I want to do what’s best for the patient in front of me!” At NEQCA, we couldn’t agree more. We want all of our clinicians to provide the best care possible for every patient, period. For an individual patient, this may well increase cost – for instance, by using newer, evidence-based, but more expensive therapies. However, we know that up to 30-40% of care is unnecessary, redundant, and wasteful, estimated to represent around $700 billion annually.

Many of the strategies I pointed out in my recent article on Population Health Management can reduce cost and improve care: using registries to identify high-risk patients and making sure to get them in for preventive and screening care, coding appropriately to be compensated at the level we deserve, and coordinating care to use the specialists and hospitals who provide both great quality and lower-cost care.

Using tools like those available through Choosing Wisely, and discussing clinical decisions with patients, improves doctor-patient relationships and reduces waste. Keeping patients out of the emergency room and reducing unnecessary readmissions, keeping appropriate patients at home for their post-op or palliative care, using medication regimens that are equally effective but less expensive – all have a positive impact not only on cost, but on the overall patient experience, clinical outcomes, and even physician burnout. The components of the Quadruple Aim are interdependent.

As NEQCA’s leaders discussed through our 2017 State of the Network conversations, and are reaffirming through the development and implementation of our 2018 Performance Improvement Plan, quality remains the gate to surplus dollars, but – increasingly – only with improved efficiency. Clinical and administrative leaders from across our network, from Lowell to Cape Cod, are rallying around the need to improve our efficiency scores and are sharing best practices and learning from one another. They understand that reducing unnecessary care and lowering overall costs will ensure that we have the dollars to spend on those tests, medications and procedures that some of our patients really need, so that we can continue to be confident that we’re always providing the best care for all of our patients, every time! Being better stewards of health care resources doesn’t undermine the quality of our care – it helps improve it.

Read my December 2017 article on Higher Clinician Satisfaction

Read my March 2018 article on Better Health

Watch NEQCA's Quadruple Aim Video