Higher Education: Take a Lesson from Health Care

Higher education will look dramatically different in ten years. Where health care stands today offers lessons both good and bad in how to reform oneself.

Health care reform is one of the top priorities for new administration. But, talk to any current, recent or prospective college student or their parents about college costs and you'll realize that higher education isn't far behind in terms of its own crisis.

We work in both worlds and know first-hand that the two issues share common problems. Without a concerted effort they could share similar fates.

Consider this: As Obama made clear on December 11, 2008, despite an economy in recession and a six-year war being waged on two fronts, health care reform remains near the top of his national agenda. If health care reform legislation moves forward next year, which is a good bet, the government will decide what reform looks like, not the health care industry.

Higher education still has a chance to save itself. As Arne Duncan considers his new role as Education Secretary, those in leadership roles in the higher education community, including the presidents of colleges and universities and their trustees, must be willing to learn from the failures of the health care industry -- and voluntarily reform.

Costs for both education and health care are beyond the ability of many families to pay.

According to Measuring Up 2008, a recently released report, college costs have risen 439% from 1982 - 2006 - at a much faster clip than medical costs. At the same time traditional ways of paying for college are drying up -- credit for student loans is tight, home equity as a source of funding has disappeared, and state funding for higher education is falling by the wayside as they grapple with their own accelerating health care costs.

While medical care is (or should be) a necessity, postsecondary education was long seen as the privilege of a select few. This is no longer true in today's economy. With unemployment topping 6.5 percent, only the most educated will find new jobs quickly. In addition, two-thirds of all newly created jobs will require a college education or advanced training.

Higher education is not just a domestic issue. Our international economic competiveness is at stake as well. According to the Organization for Economic Cooperation and Development, among industrialized nations, the US has fallen to 10th place in the number of adults who have completed college. Our economy will never recover, much less grow, if we don't return to our former first in the world status.

If the post-secondary world wants to avoid government-mandated solutions to the fundamental challenges of access, cost and completion, colleges and universities should take their cues from several promising reforms gaining currency in the health care reform debate. While there are many examples to choose from there are three that college presidents and trustees can learn from: 1) patient-centered reform; 2) prevention; and 3) evidence-based decision-making. Let's look at how those three can be applied to higher education.

1) Patient-centered reform: Health care reform on Capitol Hill will focus on patient-centered solutions. For example, the National Quality Forum's National Priorities Partnership recently released a set of priorities that lead off with the creation of a patient centric health care model. As we have learned in this arena, major reforms don't succeed unless the end users are part of the solution. This is their leading priority:

Patients who are engaged as active partners in their health care... are vital to achieving better health outcomes, lower service utilization and lower costs.

In contrast, higher education policy still tends to focus on what is best for institutions, not the students. With a few tweaks, the National Quality Forum's language could easily be adopted by the education world:

STUDENTS who are engaged as active partners in their POSTSECONDARY EDUCATION ... are vital to achieving better POSTSECONDARY EDUCATION outcomes, lower service utilization and lower costs.

Higher Education should put consumers - the student - at the heart of the debate.

2) Prevention: Another focus area for health care legislation will be prevention. Reformers
have long recognized that spending a small amount up front to prevent illness has the potential to save billions of dollars on the back end. According to an article in the New England Journal of Medicine:

Preventable causes of death, such as tobacco smoking, poor diet and physical inactivity, and misuse of alcohol have been estimated to be responsible for 900,000 deaths annually -- nearly 40% of total yearly mortality in the United States.

In the same way, more students will succeed at a lower cost if we do a better job of preparing them for the work they will be doing in college. ACT found that only 25 percent of the 1.3 million American students who took their college placement exam in 2007 were ready for entry-level college courses in english, mathematics, social science, and natural science.

According to National Center for Education Statistics data released by Strong American Schools, "remediation in public institutions costs roughly $2.5 billion every year to provide students with the content and skills that high schools failed to provide them." As a nation, we are paying twice and wasting billions of dollars for the education that students should be receiving in high school.

The higher education community must work closely with the K-12 community to better align expectations and required skills for high school graduates.

3) Evidence-based decisions: During the presidential campaign, both sides embraced the notion of comparative effectiveness - choosing health interventions and life saving drugs, not because we think they will work, but because we know they will work based on the evidence.

Used appropriately, comparative effectiveness could result in policies that will improve health care quality and ultimately value by providing patients, physicians, and other health care providers with sound data upon which to base decisions.

The post-secondary education system in this country does a poor job of collecting and using data to make evidence-based decisions. Even worse, parents and students have severely limited access to information that will help them make good decisions about which college or university might be best. As the Secretary of Education's Commission on the Future of Higher Education noted, there is "a lack of clear, reliable information about the cost and quality of postsecondary institutions, along with a remarkable absence of accountability mechanisms to ensure that colleges succeed in educating students."

Policy makers, higher education administrators, and consumers alike must be able to make informed decisions based on evidence.

States should ramp up their efforts to build data systems that track outcomes for students at all levels and work to ensure that this data can be compared across institutions and states.

The postsecondary education system still has the opportunity to voluntarily make changes that will: Put the needs of students first, cost less, and help fix our economic woes. But if they wait too long, the government will step in.

Higher Ed - take a lesson from health care.