The document discusses improving the value of American healthcare over the past 30 years. It notes that while various remedies like managed care plans, consumer directed plans, and accountable care organizations have been tried, healthcare costs still persist too high. The document suggests that large employers need to play a role by steering employees to higher value clinicians and lowering overall prices to finally address the ongoing issue of high healthcare spending in the United States.

1. ©2019 Milstein©2019 Milstein
Large Employers’ Role in
Improving the Value of
American Healthcare
Arnold Milstein
Stanford Professor of Medicine
PBGH Medical Director
USC Annenberg Center Webinar
July 23, 2019

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Great US Care Can Cost Less
Source: IHA 2012
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Performance of 200+ California Physician Groups Accountable for Value
Tomorrow’s Positive value outliers
Annual Risk-Adjusted Total Healthcare Spending Per Commercial Patient-Year
QualityCompositeScore
Today’s Positive value outliers

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30 Years of Insufficient Remedies
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 PPO Discounts
 Managed Care Plans
 Consumer Directed + Wellness Plans
 Enhanced Primary Care
 Accountable Care Organizations
 Virtual Care

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Data from: Kaiser Family Foundation analysis of Medicare spending data from Boards of Trustees; private health insurance spending data from the CMS
National Health Expenditure data; GDP data from BEA (historical) and CBO (projected), and CPI data from the BLS (historical) and CBO (projected). Cosmetic
dentistry by, Arnold Milstein
Though Each Narrowed the Jaw
Opening, Predation Persists
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The Road Ahead
• Reluctance to Increase Deductibles
• Steering to Higher Value Clinicians
• Lowering Prices
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