Thursday, August 23, 2012
George McGregor, a health care administration who developed the Medical Appropriateness Project
Dr. R. Adams Dudley, Professor of Medicine and Health Policy at University of California San Francisco
As San Diego schools struggle with tight budgets, they are looking to health care as a place to cut costs. Both the San Diego teachers union and the County Board of Education voted this summer to endorse a new program called the Medical Appropriateness Project, or MAP, that aims to do just that.
George McGregor, a health care administrator who developed the project, told KPBS the 45 school districts in California that use California Schools VEBA to provide health care to employees are wasting medical costs. San Diego's school districts are among them.
“We found out through some definitive studies that one in five diagnoses in our population were wrong, and that 60 percent of the treatments for those that were correctly diagnosed were old medical treatments, that there were better treatments out there," he said. "So the experts came in and gave us an estimate that we were spending $120 million a year treating diseases that our members and population didn’t have.”
He said the program identifies doctors providing quality and cost-effective health care, and then rewards employees who choose to go to those doctors.
“Then we will have physicians go in and tell us, was that good care, was that bad care," he said. "If they come back and tell us, this physician was really good, then we’re going to market that physician’s services and tell our members, it looks like this would be a really good place for you to get your health care from and we believe it will save money.”
Dr. R. Adams Dudley, a professor of medicine and health policy at University of California San Francisco, helped create the rating system to find the best and most cost-effective doctors.
He told KPBS they use records doctors file with the insurance company or employer and look through them to find care that is "not consistent with the latest science."
Dudley said the system is not designed to restrict access to procedures or care, but is only meant to ensure the appropriate procedures or care are administered.
McGregor said doctors are responding well to the MAP program. He said it is not meant to replace employer health plans, but instead to work with those plans to incentivize the right type of care.
Currently, MAP has 105,000 participants, but needs 250,000 to be statistically valid. The project is looking for other employers to join the project.
Claire Trageser contributed to this report.