The Podium

In health care, go local

Here is a radical idea from a health system CEO:

If we keep people healthy and out of the hospital, care for those who are sick near where they live and work, and reserve high cost medical centers for only the sickest patients, we can crack the quality-safety-cost “code” on health care in a way we have not been able to until now.

The current model of health care is broken. Cost rates are unsustainable and will, on their current course, continue to deplete government and private sector investment from priorities like education, social services, security and municipal infrastructure. And, traditional models of care have not been very good for patients.


The just concluded Health Policy Commission hearings were an opportunity for health care organizations from across the state to address these issues and describe steps we are taking to keep costs down and how to deliver high-quality, better coordinated care.

Get Arguable in your inbox:
Jeff Jacoby on everything from politics to pet peeves to the passions of the day.
Thank you for signing up! Sign up for more newsletters here

The Commission’s focus is primarily on cost reduction, and we share that concern but cost reduction is tinkering at the margins. That said, we understand the skepticism: earlier consolidations among health-care providers in our community have not translated into savings for patients, insurers, or employers. True cost reform and actual savings to consumers will come only by totally changing the way patients access care, how providers deliver care and where patients receive care.

Stuart Altman, health-care economist and chairman of the board of the Helath Policy Commission, was recently quoted in the Boston Globe as saying, “One of the reasons that Massachusetts is so expensive is that we disproportionately use our most expensive facilities for routine care. That’s where the money goes.” Altman wants health-care providers to offer appropriate care in community settings, and use larger teaching and research hospitals only for more complex services.

We couldn’t agree more.

Eastern Massachusetts is fortunate to have a remarkable selection of superb health-care resources with incredible scope: basic science research intensive centers, teaching and clinical research hospitals and great community hospitals. However, in our region, many more patients get hospital care in higher cost centers compared to other major metropolitan areas in the country — including New York, Philadelphia, and Chicago – each of which is also fortunate to have spectacular health-care centers.


We have a moral obligation to inform patients that high quality care is available in a variety of settings and that most of their hospitalization needs can be provided with the same quality and safety, but at a lower cost, in their community hospitals.

The overall health and economic well-being of a community are enhanced when care is delivered close to home. When providers work together, we can deliver high quality care at a sustainable cost which translates to higher value for our patients, insurers, and employers. Community hospitals can provide a superior patient experience and patients are treated in familiar settings, reducing stress and anxiety. Patients who access behavioral health and senior care services in the community setting also benefit. These local institutions are not-for-profit assets of the communities they serve and should remain vibrant community resources.

It can be done. As an example, the volume of patients being seen in the community hospitals in the Lahey Health network has increased to the highest level in five years. That tells us that patients are beginning to get the message.

We need to make sure that consumers have access to real time information about quality, safety and cost so they can make informed decisions about where to get their care. We also need to accelerate the move from the old fee based reimbursement for episodic treatment to global reimbursement that pays for achievement of health.

This will not be easy but this is the direction our health care must move toward. It means educating patients so they are willing to take these important steps with us. If we are forward-thinking, efficient and apply an integrated approach when it comes to health care, Massachusetts will be a model for the rest of country.

Dr. Howard Grant is the president and CEO of Lahey Health.