Valley View by David C. Pate: How to fix health care in three (really difficult) steps

DAVID C. PATE, M.D., J.D., president and CEO of St. Luke's Health SystemMay 14, 2013 

David C. Pate

I often am asked how health care can be reformed.

Here is St. Luke's approach. I think it's the answer - in three reallydifficult steps.

1. Improve health

It is too expensive to be a patient. We must prevent, or at least delay, people becoming patients.

Projected future health care costs will overwhelm the efforts at cost-cutting that health care systems are making today if the epidemic of childhood obesity is not addressed.

Currently, 30 percent of third-graders in Idaho are obese. These children are going to develop high blood pressure, high cholesterol, heart disease, strokes and even cancer at much earlier ages than we have seen previously. This will result in both an increase in direct medical costs and workforce productivity losses.

2. Improve care

The current health care delivery system is fragmented and inefficient. We cannot get health care costs down and improve care until we coordinate care.

Once a person becomes a patient, we must ensure that every provider involved in the care of the patient has all the information available through an integrated electronic medical record, which should be available online to patients. This will reduce medical errors and needless duplication and associated costs.

Here's an example of why this is so important. I was recently told of a patient who came to us after receiving care elsewhere. The patient felt weak, and it was discovered that two different physicians had been prescribing the same medication, issued under different brand names, because the second physician did not realize that the patient was already taking the medicine.

Care for those with chronic illnesses must be coordinated among specialists and other providers to prevent avoidable hospitalizations and complications of their diseases. Developing technology will permit us to monitor patients' care at home and work, and intervene before a patient even feels ill.

If a patient requires hospitalization, we must ensure that care does not end with the hospital discharge. Discharge must be a coordinated process that ensures that patients have their medications, understand how to take their medications and have appointments set up to see their care providers after discharge.

And we need to follow up with high-risk patients to ensure they are doing well after discharge and that they see their physicians for post-discharge visits so as to reduce the high number of hospital readmissions that occur within the first 30 days of discharge.

More care needs to be delivered by teams of providers and in patients' homes. Some conditions for which patients are now admitted could be cared for in the future with home health nursing visits several times a day, a video camera, remote monitoring of vital signs, and technology that exists today.

3. Reduce costs

These solutions will result in lowered health care costs, but there is much more to be done.

The Institute of Medicine believes that at least 30 percent of health care spending does not benefit patients. If this activity stopped, significant savings would be achieved.

You may think that this is a futuristic view of health care. You would be wrong.

St. Luke's is gaining on these goals. They are our Triple Aim. Read more about these programs and initiatives at


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