Outta the way: Should the private sector take the lead on healthcare reform?

As the number of federal laws and regulations governing healthcare grows, some critics have asked: Why not allow the private sector to take the lead in figuring out how to rein in costs and improve quality of care?

While it may seem that the federal government is making all the plays, the private sector is taking its own actions.

The Healthcare Leadership Council, for instance, has been tackling the challenge since its inception in 1988. In its most recent report, The Future is Here: Transforming American Healthcare Through Private Sector Innovation, HLC chronicles the efforts of a broad spectrum of healthcare players that are looking for creative ways to provide more cost effective services, including insurance plans like Aetna, health systems like the Mayo Clinic, drug companies like Merck, device manufacturers, such as Medtronic, retail pharmacy chains like Walgreens, large distributors like Cardinal Health, and group purchasing organizations like VHA, Inc.

[See also: Disruptive Innovators: Businesses partner with health insurers.]

To achieve better quality and lower costs, HLC’s members have started innovative programs, like the Cleveland Clinic’s Center for Lifestyle Medicine, which features a Lifestyle 180° program for patients that includes practical nutrition education, hands-on cooking classes, exercise instruction, instruction in breathing and meditation, and stress management.

“A lot of people think that improving quality is going to cost more,” said Mary Grealy, HLC’s president, “but at the end of the day, if you can get better outcomes, you are reducing the overall cost.”

The Lifestyle 180° program has generated statistically and clinically significant health gains, the report said, including weight loss and drops in cholesterol or blood glucose levels, but the report provided no financial data.

The projects outlined in the HLC report are only the tip of a much larger iceberg. Other companies not associated with HLC are innovating to improve healthcare.

Organizations like Doctors Making Housecalls, for example. Doctors Making Housecalls is working to make patient care more cost effective from a different angle. This medical group’s belief is that delivering highly personalized primary care to frail, elderly patients who rarely get to the office can fend off healthcare crises and reduce the number of ER visits and hospital admissions. 

[See also: Disruptive Innovators: Physician house calls making a return.]

“Our approach eliminates barriers to access and that allows physicians to function in a much more proactive, prevention-oriented fashion,” said Alan Kronhaus, MD, said the CEO and founder of medical group.

While private sector initiatives like Lifestyle 180° and Doctors Making Housecalls are promising, Jon Handler, MD, CMIO at M*Modal, a healthcare IT solutions firm, isn’t convinced that they can transform the healthcare industry on their own, partly because the government is such a big payer in the system and sets the rules that the industry follows.

“Private industry is going to be a key player in improving quality of care at lower cost but they can't do it alone,” he said. “They will need help and partnership from the government to make it happen.”