Rest-in-peace, Hummer. Last week, GM announced that after 18 years, the gas-guzzling icon of car excess would be tossed to the proverbial scrap heap.

The Tale of the Hummer provides a useful parable for American health care, especially for context this week as the annual HIMSS conference kicks off. (Please skip to the end-note to learn more about HIMSS, for those Health Populi readers unfamiliar with the acronym or organization).

Why did GM send the Hummer to its resting place? There are several factors that eroded the demand for the Hummer: among them,

  • First, the price of gas, generally trending up; in July 2008, it would have cost $131 to fill the Hummer’s 32 gallon tank. That sticker shock hit Americans a few months before the recession officially began in December 2008. But it was the season that ushered in Americans who once would never consider hybrid cars to take a look at them.
  • Second, the recession itself. With the economic decline has come more Americans doing more at home, and if choosing to take vacations, opting for the “staycation.” That means driving more within a region, which means scrutinizing gas prices as a component of the total cost of the trip.
  • Third, an ethos has begun to take hold with the American consumer: value-based shopping. More Americans are purchasing private-label goods from grocery stores and department stores. Today, value is in the eye of the purchaser.
How does the story of the Hummer’s demise relate to U.S. health care in 2010? Health care costs have grown at unsustainable rates. The component costs of care are all rising above and beyond the increase of general price inflation. We’re not getting good value for our money: we’ve a wasteful system that consumes too many resources for the outcomes it achieves — here, think of outcomes as MPG.

In health, the 3 Hummer market dynamics translate as follows:

1. Health price sticker shock has meant higher hospital bad-debts when patients check out of ERs and inpatient beds, fewer prescriptions getting filled, and more recommended tests and treatments getting postponed or skipped.

2. The “staycation” metaphor in health is more health consumers doing DIY-health: sometimes for the better, often resulting in medical mistakes or mis-steps. Choosing to cut prescribed pills, for example, can be short-term fiscally smart, but in the longer term physically harmful.

3. Value-based shopping in health is largely a positive phenomenon when done with full information. The growth of generics has been fanned by both mail order pharmacy for chronic meds, as well as consumers’ response to $4 prescriptions for generics offered by big box discounters and retail pharmacies. Value-based care is also permeating the mindset of employers who buy health benefits on behalf of employees.

Health Populi’s Hot Points: The moral of the Hummer’s Tale is sustainability. Health care in the U.S. is an unsustainable model. We can’t just sell it off as an under-performing asset, as GM tried to do last week in selling Hummter the Chinese industrial group, Sichuan Tengzhong. The Chinese govenrment said, “no way.” In fact, no entity would buy the U.S. health system were it to be sold on the global open market.

It needs re-engineering. To fix health care, we have to pay for what works: and to pay for what works, we have to measure what we’re doing. That’s where HIMSS, and health information technology, come in to play.

This week, as many as 30,000 attendees will walk the floor of HIMSS to kick tires on electronic health records systems, wireless devices, digital imaging systems, medical banking systems, and other technologies that will drive paper out of health processes. The intelligence of President Obama’s including $19 billion of stimulus funding in ARRA for health care IT was that, with those investments, over the longer term, the U.S. will be able to measure health care processes and outcomes. This will enable Medicare, Medicaid and commercial payers to sort out how much to spend, on what health care services, and to whom.

The promise of HIT, though, can’t do the heavy-lifting of healing health care alone without health payment reform.

Most Americans who get health care services are receiving Hummer-style healthcare: it may look fancy, with its innumerable bells and whistles, and perhaps by some be considered “the best in the world.” But under the hood, it’s incredibly wasteful and unsustainable.

End note: HIMSS, the Health Information Management Systems Society, is the leading organization advocating the adoption and optimal use of health care information technology. The annual meeting attracts thousands of stakeholders representing health care providers, technology developers and vendors, financiers and VCs, government agencies, telecommunications, and other groups interested in health care IT. Last year attracted some 27,000 attendees; this year could bring even greater attendance given the hot topic of health IT.

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