1. Lessons From Abroad: International Efforts to Improve Quality, Reduce Costs and Increase Transparency Robert S. Galvin, MD Bipartisan Congressional Health Policy Conference January 13, 2007

2. 2 Robert S. Galvin Bipartisan Congressional Health Policy Conference January 13, 2007 Lessons From Abroad Where The U.S. Is Different Much Larger, More Heterogeneous Population Health System Much Less Centralized…By Design(?) - Federal vs. State vs. Private Sector No Consensus On How To Control Costs Very Medical Innovation-Technology Friendly Where The U.S. Is Most Similar Common Belief: Driving Value vs. Cost Containment

3. 3 Robert S. Galvin Bipartisan Congressional Health Policy Conference January 13, 2007 U.S. Has Been Improving Quality…Slowly

4. 4 Robert S. Galvin Bipartisan Congressional Health Policy Conference January 13, 2007 Strategic Framework Board - 2003 Professional Organizations Care Delivery Teams PATHWAY #2 Goals Purpose Results (Performance) Improvement Consumers Purchasers Patients Motivation PATHWAY #1 Selection + Payment

5. Hospital Death Rate (RAMR) Columbia Presbyterian3.93* Lenox Hill2.26 NYU Hospitals Center1.95 Weil Cornell – NYP0.95* SurgeonRAMR State Total2.25 Smith, C4.15 The Power Of Transparency

6. 6 Robert S. Galvin Bipartisan Congressional Health Policy Conference January 13, 2007 Payment and Improvement Current Payment Systems... Are at Best Neutral and at Worst Negative Towards Quality MedPAC 2004 (2004)Institute of Medicine (2001) If I keep getting better, Dr Galvin, Im going to improve myself right out of business Glen Hackbarth Purchasers should…Remove Barriers that…Impede Quality Improvement And Build In Stronger Incentives For Quality Enhancement

7. Immutable & Desirable Ageing Technology Unhealthy Lifestyles Malpractice End of Life Care Cultural System of Care Uninsured Administrative Costs High Prices/Specialist Incomes Waste and Quality Shortfalls Lack of Accountability/Transparency Health Costs: Lots of Opportunity, Little Focus