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James R. Knickman

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The Moneyball Approach to Health Care

Posted: 10/04/11 08:30 PM ET

I'm always surprised that some people still buy into -- and perpetuate -- the myth that America has the greatest health system in the world. We spend so much money on health care, but those dollars have not translated to good health. Every patient and every health-care professional can cite many instances of unnecessary services and questionable quality of care.

Just one example related to New York: AARP, the Commonwealth Fund, and the SCAN Foundation recently partnered to produce a scorecard about the quality of long-term care in each state. New Yorkers spent a higher percentage of their income for nursing home care than residents of almost every other state (only Alaskans had higher rates). But we don't get better care for that money: New York ranks 44th in the nation for nursing home residents with pressure sores, a key indicator of health-care quality, and we offer very few services to support the family caregivers who are central to helping frail elders.

More care isn't always better care, and more money doesn't always buy better health. Particularly during these tough economic times, we need to be smarter about how we deploy our health care dollars. We need to take the Moneyball approach!

The new film Moneyball tells the true story of the Oakland As baseball team's transformation during its 2002 season. The manager, Billy Beane, is losing his superstar players to well-heeled teams like the Yankees. The As have only a tiny fraction of the Yankees' bankroll, and can't attract big players who command big money. Simply, Beane needs to produce better outcomes and more quality baseball with a set of fixed resources. This sounds like a familiar challenge that also faces every health care provider today.

Without spoiling the movie, I'll tell you that Beane's approach led to the As breaking a record that season for most consecutive wins. This following point will not surprise people who know my background: the real hero of the movie is not Billy Beane, but the economist who crunched the numbers and walked him through the statistics! Beane took advantage of a clever use of experiential information and analytical ability to get better outcomes with scarce resources.

Beane was able to build the right team because he pored over datasets and found the right people for the job: players who could get on base, and who other teams were undervaluing. Beane also disregarded data points that other managers cared about but that had little proven effect on a player's contributions to a team (a player who had a funny style of pitching, for example, or one who could make saves but couldn't get on base).

We in health care also need good data to drive smart decisions. To get better health outcomes, we need to unleash epidemiologists (the creative analyzers of data in health care) and quality improvement specialists (the people who can translate experience into better practice) to get better outcomes in health care. Every health-care CEO needs to have a bit of Billy Beane in his or her personality.

Good data, good analysis, and good quality improvement experts can help us answer the pressing issues facing health care: Which models of care are most effective at delivering high-quality patient care and good health outcomes? Which interventions and procedures are cost-effective? What drives variations in care?

To answer these questions, we need to generate, share, and analyze data that will help us make smarter decisions about how to invest our health care dollars and how to structure a reformed health system. The baseball system invests in statistics and shares them openly with every team and every fan. Transparency is universal. We need to do the same in health care. The data exist these days. Now let's get the information in a format and in a place (a cyberspace, that is!) so it can be analyzed, and so outcomes and processes can be compared across hospitals and across patients. Then leaders, managers, and advocates can use the data to drive improvement in our system.

Even though some of us love the Yankees, who have won by spending lots of money, let's try to learn from the Oakland As that you can have good quality outcomes by using resources smartly. I know, I know the criticisms I will hear from my baseball friends: The As still have not won the World Series!! Well, this just shows that data and analysis and being smart about resource use is not all that is important. We still need dedicated leaders, passionate providers of care, active consumer activists, and enlightened public policy makers to create a really high-performing health system. I think we can count on New York to produce all of these ingredients also, so we can both work smarter and bring home more health care wins.

 

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