A group of health care experts, local payers, providers, patients and other stakeholders participated in the Going Below The Surface (GBTS) Forum’s first ever virtual town hall meeting on Sept. 22 in Austin, TX. Participants zeroed in on two difficult questions: how much do we want to spend on health care, and how do we want to spend those dollars?

Organized by the Healthcare Leadership Council (HLC), a partner in the GBTS Forum, the town halls are an ongoing effort to spark a national dialogue on health care spending, as well as to engage community health care leaders at the state, regional and local level to call attention to health spending topics and potential solutions.

Dr. Robert Dubois, Interim President and CEO and Chief Science Officer of the National Pharmaceutical Council (NPC), reminded attendees that concerns about health care spending in the United States are nothing new. In 1960, health spending accounted for about five percent of GDP. It doubled by the late 1980s and rose to nearly 15 percent at the start of this century. It’s currently at 18 percent and is projected to hit 20 percent by 2028, Dr. Dubois noted.

Rising health care costs are affecting access to health care as less and less people can afford to pay their premiums and deductibles. In fact, Texas has the highest rate of uninsured adults in the entire country.

A serious dialogue on spending requires us to go below the surface, noted Dr. Dubois, as the participants pondered a serious question: are we spending too much on health care? The answer came quickly: it depends on whom you ask. The attendees, based in the Austin and Dallas-Fort Worth metro areas, had different perspectives on the health care needs and hardships of their surrounding communities and what factors were driving health care spending.

From the payer perspective, nearly 60 percent of employers provide health insurance to their employees and employers cover about 92 percent of all working adults under the age of 65. Many people complain about the cost of insurance, but when they get sick, they want access to all the available care they can get courtesy of their plan provider. Those without insurance, however, would probably argue that health coverage has become unaffordable and there is way too much spending for anyone’s good.

Self-employed workers in Texas, meanwhile, are paying three to seven times more for health care than other workers, but there doesn’t seem to be any correlation between cost and quality within the different rates, according to claims data researched by one of the participants.

One attendee offered another example: a huge percentage of our money is spent on health care at the end of our lives, even though many of those dollars will likely provide little additional benefit to our quality of life. “We need to change our mindset that we can live forever,” they urged.

During the main discussion and the subsequent breakout room sessions, participants brought up other factors related to the management of health spending. Among those:

  • a new Rand report that studied the commercial insurance claims of 4,000 hospitals found that there was little correlation between prices and quality ratings.
  • the largest nonprofit hospital system in the Houston area is spending a big percentage of its budget on preventive care at school districts that have the highest obesity rates and lowest social strata in the state, and it’s seeing a big return on its investment: emergency room use by that segment of the population has decreased significantly.
  • telemedicine has jumped from 2,000 to 40,000 virtual visits in the past four months at an Austin area health system due to COVID and aided by federal waivers.
  • a health care provider in Houston is re-imagining access to MRIs – scan time is decreased, and the patient only pays $250 instead of the thousands of dollars it usually costs. Most of the patients are uninsured.
  • a health and benefits group in the Dallas area developed a new protocol for treating back pain that has reduced the need for surgery: patients start with 30 days of physical therapy – surgery is a last resort.

Although they didn’t come up with a clear answer, the town hall attendees did agree on one theme: what’s important is not how much we’re spending, but what benefits we’re getting for the money we’re spending. The benefit is paramount, and the answer lies somewhere in that word’s actual meaning: the right care at the right time with a good outcome at affordable costs.

The participants from this event are planning to continue their serious dialogue on health care spending at a follow-up virtual town hall in Austin in November. The GBTS Forum is also planning to host a virtual town hall in Richmond, VA, in December.