This weekend's Dartmouth Summit on Health Care saw Dartmouth undergraduates join students from Dartmouth Medical School and the Tuck School of Business to discuss the improvement of health care delivery as a solution to rising health care costs. At the summit, held at Tuck, Harvard Business School professor Michael Porter and Harvard Medical School professor Andrew Ellner helped students brainstorm more efficient means of health care delivery, including altering financial incentives and improving investment strategies.
The discussion took the form of two case studies, in which students analyzed the operations of the Spine Center at Dartmouth-Hitchcock Medical Center and care delivery at the Rwandan facilities operated by Partners in Health, an organization co-founded by College President Jim Yong Kim.
In both cases, students debated efficient strategies to deliver high-value health care. Porter defined "value" as health outcomes divided by the total cost of care delivery.
"There's been very little work on how to think systematically and strategically about the actual delivery of care," Porter said, adding that work should focus on providing the highest possible value of care to patients.
For 25 years, policymakers have tried to improve value by lowering the cost of delivery, but the approach has been largely unsuccessful, Porter said. Instead, he concluded, reformers should focus on improving health outcomes to achieve a higher value of delivery.
"If we can improve the numerator, that's the way to ultimately reduce the denominator," Porter said.
Several students suggested that needless care should be eliminated to improve health outcomes. Over 30 percent of the health care delivered in the United States today is "unnecessary," according to Dartmouth Institute for Health Policy and Clinical Practice director James Weinstein, who spoke at the summit.
"Care that is important is often not delivered, and care that is delivered is often not important," Weinstein said.
In the Spine Center case study, the Center acts as a "one-stop shop" for all spinal injuries in the Upper Valley, according to Porter. The Spine Center technically operates at a loss because it collects revenue only from care provided directly at the center and has high overhead due to various administrative costs, Porter said
One student pointed out that many other departments gain revenue from imaging and surgery directed by the Spine Center. Identifying the Center as a "revenue center" for this reason rather than as a "cost center" would help it gain additional credibility and allow for more rational investment decisions, according to several student participants.
Throughout both discussions, several students said that altering payment structure would provide a better incentive for health care delivery.
"We think the appropriate reimbursement model is a total package model around each individual condition, once a condition is diagnosed," Porter said. "We can also pay for a period of time for a chronic disease or for primary or preventative care."
Students considered the details and possible solutions of each case study, which they had studied prior to the summit. While Porter and Ellner helped to guide the discussions, they did not answer specific questions or provide additional information. Each case included one hour of discussion followed by concluding comments by the professors.
The student participants, who were selected based on written statements of interest, gathered in the Ankney classroom, while faculty and other observers watched a live stream of the discussions in a neighboring classroom.
Several students interviewed by The Dartmouth said they were impressed by the diversity of individuals and perspectives present at the summit and praised its organizational format.
"For one thing, it brings everyone's experiences to the table, and it's great to have MDs and MBAs and undergrads all in the same room," Yang Wei Neo '12 said.
Kate Vonderhaar '10 said she became interested in attending the event because of its relevance to her future plans.
"I think it's really nice that people have been so engaged," Vonderhaar said. "The case study method is a great way to use a specific example as a launching pad for discussion."
