Baseball and US healthcare

If you’re a baseball fan than you’re likely mourning the end of the season and likely familiar with the concepts of “moneyball” and “sabermetrics” and the use of statistics to infer trends, future performance and player investment or drafting strategies. It counters the traditional methods of judging future performance on the basis of personal observation and informed opinion. The concept is most closely associated with Billy Beane, general manager of the Oakland Athletics, and (in theory) explains why small-market teams such as Oakland are able to compete with large-market teams whose budgets dwarf the latter.

This concept of statistic-driven outcomes has its equivalent in healthcare: evidence-based medicine. Yet despite its theoretical value, it’s still rarely used and tough to access. As Billy Beane, Newt Gingrich and John Kerry note in a recent New York Time op-ed, “a doctor today can get more data on the starting third baseman on his fantasy baseball team than on the effectiveness of life-and-death medical procedures.”

All this despite the fact that the US spends more than twice per capita on healthcare than any other country in the world, ranks amongst the worst industrialized countries on health quality, and sees nearly 100,000 Americans killed every year by preventable medical erros. You’d think a moneyball/evidence-based medicine approach to healthcare would gain more traction.

Back in 2005 we (then New Paradigm) authored a series of reports on the future of healthcare and how evidence-based medicine was a necessary next step based on research and early trials that showed tremendous benefits in terms of cost savings, cost avoidance and ultimately patient outcomes. One of the companies we profiled as part of this research was InfoPoems, now known as Essential Evidence Plus, and their business focused on providing peer-reviewed EBM summaries at the point of care. At the time we noted, “In a consumer centric system consumers and physicians make decisions based on informed consideration of meaningful evidence. POEMs—patient oriented evidence that matters—offer proven research summaries relevant to physicians and their patients… Which in an age of 18 minute patient-physician interactions could mean the difference between life and death.”

But fast forward three years and we’re still saying the same thing, and as the authors of the op-ed note, we’ve made precious little progress outside of a few small-scale implementations.

What’s holding back progress in the US?

A likely cause is the uncoordinated nature of a multi-payer system, and the lack of a joint federal government / private sector push for EBM. Collaboration in health care is part of a needed solution to both reduce cost and improve outcomes in all jurisdictions, as is the release of health care data to the public related to outcomes, thus allowing concerned citizens, employers and government providers and payers to work together to help find solutions.

Whether or not such an approach allows health care to emulate small market baseball teams that manage to win is still to be determined but given the current state of affairs, not moving towards stats and EBM is a step that a new administration can’t afford to take.

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