American People's Online Health Summit

AMERICAN PEOPLE'S ONLINE HEALTH SUMMIT

Center for Health Transformation

 

An ongoing, online Summit with the American People to discuss solutions to transform our country’s healthcare system.

 

Featured topic today Friday February 19, 2010

 

Individual-Centered Health: How to Put Health Back into Healthcare

 

What do you, as Americans, need in order to be healthy and make good decisions about your care and the care of your loved ones?

 

First and foremost, the American people are human and deserve the highest quality personalized and individualized care.  They have the right to know cost and quality information in order to make the best decisions for their health.  In order to be the healthiest they can be for themselves, and to be part of a productive workforce and to reduce the need for expensive care, we must focus on prevention, wellness, health management and the best interventions to manage complex chronic conditions.

Americans need insurance coverage that is affordable, accessible and appropriate.  We must provide incentives for Americans to seek the best care at the  best price.  Similarly we need to provide incentives for hospitals, physicians, and other providers to give top quality care at the best price.  Real reform must include efficient and effective ways to pay for high value outcomes rather than high volume visits and procedures.

What steps do you think need to be taken to create a health and health care environment that saves lives and saves money for individuals, communities, states and the nation as a whole?  Since you weren’t invited to the summit, what would you like policy makers and the president to hear? What are solutions that will work?

 

Dwight Mankin, NCN

Can Transparency Really Reform America’s Healthcare?

Transparency in healthcare pricing has become the industry’s hottest topic, as well as our nation’s hope for real healthcare reform. The American Hospital Association (AHA) believes “people deserve meaningful information about the price of their hospital care.”¹ But the question remains as to how patients, payers and providers can realistically expect to find common ground on the subject, much less implement a defensible solution that will begin to turn healthcare away from the current model of inflated charges that offset the “deep” discounts of primary networks.

The problem with transparent charges

For most payers, transparency involves explicit detail of a provider’s charges generously made available to the patient, in hopes that the end consumers of healthcare will make better-informed decisions as educated “shoppers.” Yet if all options available represent excessive prices by each of the providers in consideration, how does this transparency really drive any price reform that will ultimately benefit patients? According to Mike Leavitt, former Secretary of the Department of Health and Human Services, “Americans know the price of almost everything they pay for, except for one of the most important things they pay for—their healthcare.”² The real solution lies in transparency of provider costs, not simply provider charges.

JANUARY 2009

Let’s be realistic

Starting with a provider’s cost and allowing margin above that cost brings healthcare pricing back into accountability. Certainly, provider expenses for a procedure performed at a teaching hospital will differ significantly from the expenses on that same procedure in a rural hospital. So if transparency is to have a positive impact on healthcare costs, pricing methodology must include relative benchmarks that allow for variances such as location, severity, facility size and dozens of other factors.

In defense of defensibility

For transparency to bring about true healthcare reform, its basis for pricing must be

clearly applicable to any healthcare provider without burdening the independence of those providers to self-guide, respond to trends, make a profit and all the other facets allowed by free enterprise. The defensibility of such methodology only stands if costs—not charges—are the root of the information transparently shared with both the patient and payer as compensation for healthcare is rendered to providers.

1 American Hospital Association Board of Trustees, “Hospital Pricing Transparency,” April 29, 2006, American Hospital Association,

http://www.aha.org/aha/content/2006/pdf/5_1_06_sb_transparency.pdf (accessed December 17, 2008).

2 Department of Health and Human Services; Secretary Leavitt; Capitol Hill Publishing Corp.; 2008. “Transparency in healthcare a priority,”

http://thehill.com/healthcare-may-2006/transparency-in-healthcare-a-priority-2006-05-10.html.

Healthcare

What do you, as Americans, need in order to be healthy and make good decisions about your care and the care of your loved ones?

There’s a bright spot on the horizon for health reform, and it’s not coming from a federal mandate. The promise for real reform comes from patients becoming more involved as consumers. Their involvement has been fueled by amazing growth in Consumer-Directed

Health Plans (CDHPs), which typically include a high-deductible medical plan option and a health savings account (HSAs).

For the past few years, there has been a lot of buzz about CDHPs. As employees face this new option at open enrollment, more and more of them are taking this route. In fact, CDHPs were the only type of plan to show enrollment growth in 2008 as a percentage of all employees covered by health insurance—from five percent to seven percent. Among employers with more than 500 employees, these offerings jumped from 14 percent to 20 percent.¹

When the patient becomes the payer, some reform will be a natural by-product, merely from the fact that people are asking, for perhaps the first time, “How much does this cost?” As people have grown up with employer-provided health insurance, they’ve never had to share any of the premium burden until recently, so a sense of entitlement has taken hold. When one merely has   $20 co-pay, there’s no incentive to be involved in the financial transaction. Now, consumers will be less likely to tolerate outrageous charges by providers.

While employers are saving money by incorporating CDHPs and HSAs as part of their health plans, consumers are also benefitting by becoming more involved in the healthcare system—a system that desperately needs some rational-thinking consumerism. This health insurance option is a step in the right direction toward a more rational approach to healthcare financing.

Health Insurance vs. Other Types of Insurance

Health insurance is different from every other type of insurance in that it’s the primary payment mechanism, not just for expenses that are unexpected and large, but for nearly all healthcare expenses.² We are so accustomed to this, that we don’t see how ridiculous it is. We don’t pay for electricity with homeowner’s insurance or gasoline with auto insurance—we shouldn’t expect routine medical bills to be paid with health insurance. The whole point of insurance is to help mitigate loss from unpredicted and catastrophic events.

Consumer involvement in healthcare already has a success story on which to build.

Medical procedures often not covered by traditional health insurance, such as LASIK and cosmetic surgeries, exist in a competitive environment typical of most other industries. People who get procedures like these and other uninsured treatments actually behave like consumers—they have information readily available to them through normal consumer search channels, such as the Internet and advertising. A customer of these services can find price and quality information the same way as they do for most consumer goods and services.³

In behaving like consumers, patients actually drive innovation up and prices down. Healthcare is the only major industry in which a customer does not have easy access to comparative cost information; however, things are changing. In the face of this burgeoning consumer movement, hospitals interested in staying a step ahead of their competitors are scrambling to provide improved customer service, including the providing of estimates. Hospitals making this type of effort put themselves in a much better position to generate patient loyalty.⁴

Cost-Based Approach: Patients Become Consumers

Will Consumer-Directed Health Plans solve all the nation’s healthcare ills? No, but they will go a long way in arresting the unsustainable growth of U.S. healthcare costs, which are currently at almost 18 percent of GDP. The government is not known for its expertise in cost reduction; responsible families acting as consumers are. As consumers ask, “What does this cost?” more effort will be forthcoming in providing them information to make better decisions for their families.

NCN works hard at empowering people to be better purchasers of healthcare. NCN’s informative website provides consumers the necessary data to make informed decisions about their healthcare costs. Innovative tools, such as NCN’s Consumer Scope, utilize cost-based methodology to provide consumers the information they need on hospitals, actual costs, charges and appropriate pricing for any level of medical care.

The American people must take responsibility, and get educated about the fundamental causes of our nation’s healthcare crisis. Doctors, insurers and pharmaceutical companies work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well, but they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a healthcare system with incentives that generate terrible and perverse results. Incentives that:

· emphasize health care over any other aspect of wellbeing

· emphasize treatment over prevention

· disguise true costs

· favor complexity

·  discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that – most important – remove consumers from our irreplaceable role as the ultimate ensurer of value. 2

1 American Association of Preferred Provider Organizations (AAPPO) 2009 Survey of Consumer-Directed Health

Plans, April 2009. http://www.aappo.org/UserFiles/File/2009%20CDHP%20Study/CDHP_Final_Sm.pdf

2 How American Healthcare Killed My Father, by David Goldhill. The Atlantic, September 2009.

http://www.theatlantic.com/doc/200909/health-care

What steps do you think need to be taken to create a health and health care environment that saves lives and saves money for individuals, communities, states and the nation as a whole?  Since you weren’t invited to the summit, what would you like policy makers and the president to hear? What are solutions that will work?

Over the last few months we have seen a spotlight directed at healthcare.  Whether the debate is focused on access or cost, we are faced with dealing with the structure and delivery of healthcare for the future.  But as the debate goes on, one has to ask the question, “How did we get here?”  It is by asking the question and answering it in an intelligent manner are we best able to avoid the mistakes of the past and provide a workable solution for the future.  We cannot afford to have history repeat itself.

What Happened
For decades, the concept of pre-negotiated discounts for in-network care has been the most common approach for keeping rising healthcare costs at bay. Employers keenly focus their cost-containment efforts on in-network services offered by PPOs, since between 70 and 90% of medical expenses of insured patients are incurred on in-network procedures.¹ So if most insured procedures are in-network with deep, negotiated discounts, why are medical costs so extreme and health insurance premiums so high?

The Promise of Steerage

What does the PPO vendor have to offer a provider in exchange for a deep discount? The answer is, simply, patients—what the heath care industry refers to as “steerage.” In theory a carrier approaches a provider (facility or physician) and offers a volume of customers—its members—in lieu of discounts passed on to those members. By listing the provider as part of its exclusive network, the PPO can offer its patients better pricing for that service than the patient would get otherwise. Patients want more than just discounts, they want options.

The Appeal of Options

For patients and employee groups, the price of the health insurance premium plays a huge part in selecting a PPO network, but that factor can adjust with co-pay and deductible thresholds. The real appeal is the PPO’s size and relevance of its network. For example, brokers to large employers measure their effectiveness on how well they can “fit” a company’s plan with a carrier that manages and covers the employee base with as many in-network facilities and doctors as possible. In essence, a larger, more developed network gives patients (the employee base) more choices, making opportunity for in-network pricing more likely. It is the development of these large PPO networks—and even the supplemental (wrap) networks outside them—that are a driving force in the rising cost of healthcare.

Over-developed Networks

As PPO networks expand their list of “preferred” providers, their steerage becomes less exclusive. Yet deep discounts are still required of providers to maintain their inclusion in the network. As a result, providers have to raise the “retail” cost of care to offset the discounts offered, since the discounts are not overcome by the volume and steerage expected. Bruce Japsen, long-time healthcare business reporter for the Chicago Tribune, puts it in blunt terms: “Once the market is saturated with PPOs (and HMOs), rates must reflect the true costs of delivering care plus a modest profit or the health care market will collapse.”²

A New Model

Industry veterans agree that the quickest way to bring US healthcare costs in check is real price transparency that helps the patient make informed decisions. Dr. Stanley Feld, retired endocrinologist and avid proponent of healthcare reform states that “The consumer is not stupid. When they are in control of their healthcare dollar, they will force real price transparency.”³ The “real price transparency” he refers to is a cost-based model, not a superfluous detailing of charges. Until such cost-based methodology is widely adopted by healthcare payers and providers, patients will suffer the consequences of an industry that ineffectively tries to repair itself through contract negotiations, restructured administration and expanded PPO networks.  If this if not dealt with quickly, history will surely repeat itself.

1 Corte Iarossi, “Out-Of-Network Claims Could Put Squeeze on Your Healthcare Costs,” Baltimore Business Journal, April 5, 2004.

2 Bruce Japsen, “Seniors spurning pilot Medicare PPO effort,” Chicago Tribune, March 23, 2003.

3 Stanley Feld M.D., FACP, MACE, comment on “Can Employers and Patients Trust Healthcare Insurance Companies? Part 2” Repairing The Healthcare System, comment posted September 3, 2007, http://stanleyfeldmdmace.typepad.com/repairing_the_healthcare_/2007/09/can-employers-a.html.

    

Dwight Mankin is President of NCN, national leaders in rational   payment methodology delivered in a transparent and defensible manner  

Wayne A. Sensor

Individual-Centered Care and Payment Reform
 
I hope that we could all agree that a healthcare delivery system that is truly built around the needs of the patient (or perhaps more accurately the consumer) is a good thing. Imagine if you were in control of your health and healthcare how your decisions might be different. Wouldn’t it be empowering if you really knew the quality and cost of the care to which you had access? And wouldn’t it be powerful if you had an array of choices so you could “have it your way?”
 
 As a healthcare professional of some twenty-five years, I can say without hesitation that this is largely not the case today. While hospitals and doctors certainly strive to meet the needs of their patients, our systems, processes and even payment drive just the opposite. As a simple case in point, ever stopped to consider why we have waiting rooms in hospitals? It certainly isn’t so you have a comfortable place to drink bad coffee and catch up on three-month old magazines. Quite the contrary, it is so we can efficiently queue you for the use of our equipment and personnel.
 
So that said, where do we possibly begin the transformation of this complex and massive system? I would maintain the answer lies, as does so many things, in history. Virtually every major change that has occurred in the healthcare industry has been driven by payment reform. That advent of health insurance and the creation of DRG’s are but a few examples of the impact of payment on the delivery system. Today, we pay for doctors and hospitals to administer diagnostic testing, perform procedures and admit you to hospitals. Individuals, often paying only their co-pays and deductibles are shielded from the real cost of care. And this payment scheme gives us a predictable outcome: consumption. We order tests that have little efficacy. We run to the doctor for minor illnesses. And we as a population are patently unhealthy. True transformation must start with payment reform. Let’s pay doctors and hospitals to help keep you well or to efficiently return you to health. We must also open the doors of transparency so that the market will reward performance. And we must get the American public to take responsibility for their own health by getting some of their own skin in the game.
 
Only true payment reform will transform this system in a way that meets the needs of the American public, while pushing our Nation’s cost of care down.

Wayne A. Sensor – formally the CEO of Alegent Health, is a transformational leader whose reputation is built on not only his active participation in national policy discussions regarding healthcare but also on his tenacious and innovative leadership of one of the most progressive health systems in the United States.

 

 

 

 

 

Amy Protexter

Bring on the Competition!

 

Imagine a world where Americans could truly act as consumers when it comes to their health and healthcare decisions. That world would offer:

·   A plethora of timely, relevant and consumer-friendly information about the quality of care and its cost

·   The ability to easily compare and contrast the value provided by physicians and hospitals

·   High quality healthcare services that are designed and offered with consumers in mind so that they are accessible, convenient and cost-effective

·   Competition that would drive innovation, add value and bring more choices

History has shown that when a product or service enters the consumer marketplace, quality improves, prices decrease and innovation occurs. Cameras, computers and cruises are all good examples of the enhanced quality and value consumers receive when there is healthy competition.

 

Healthcare reform efforts should begin and end with the American people in mind, encouraging and even rewarding those in the industry who pave the way for a truly consumer-centered model of healthcare. Past efforts have, in my opinion, have focused more on the needs of insurers, hospitals and physicians. By putting the American consumer at the heart of the debate, the changes so necessary to enhance quality, moderate cost and bring about better health will become a reality through good, old-fashioned American competition.

Amy Protexter is a marketing/communications executive with more than 20 years of experience in the healthcare industry, who pioneered innovative, consumer-focused marketing strategies and decision-making tools aimed at making all people better healthcare consumers.

 

William W. McGuire, M.D.

Let's put some reform in health care reform

 

The energy and rhetoric is boundless, and increasing support for "change" seems pervasive across the land.  Unfortunately, the current debate and efforts centering on health care reform are hollow and recall the debacle of 1994 -- much sound and fury, but no real change.

 

The need for change is obvious. Our nation spends far too much and gets suboptimal health care outcomes. Our health status is uneven, relative to other developed nations, yet our expenditures lead the world by a huge margin. And perhaps most alarming, our costs continue to increase, out of proportion to any gain in health.

 

We need both a will to act and a real plan of action. Pouring astronomical amounts of new money -- whether it is $600 billion or $1 trillion -- into the existing system, even if that covers millions more people, will do little more than add to our debt, increase our frustration, and make future change even more difficult and expensive. It will perpetuate our inferior health care.

 

Costs will not fall, and it is unlikely we will even slow the rate of their increase.

We must have a logical, deliberate plan of action. Here are some initial and necessary steps:

 

1. Unequivocally agree that every citizen should have access to the basic health services necessary for a reasonable life.

 

2. Define the medical services that are essential, and proven to be of value, for the realization of a healthy life. This will be challenging, but it is essential for success. We will never be able to fund a health system that is centered on unconstrained and non-scientifically based consumption, regardless of relative value. Yet that is what we have today.

 

We are suffering the economic effects of a system that allows people, generally spending someone else's money, to use whatever resources they want. And this is coupled with a reimbursement system that typically pays care providers for doing something, regardless of value or outcome, rather than focusing on the total health of the individual. We have developed a sickness focus rather than a health focus. Little wonder that costs are running away. This can be changed. But it will be hard, and it will demand that all parties abandon some of their rhetoric and self-interest in order to advance the public good.

 

A good starting point would involve using the leadership of our nation's nonpartisan Institute of Medicine, along with the experiences of other successful health systems throughout the world, to define those basic and essential health services that would form the baseline benefits of a plan for all Americans.

 

3. Mandate that all people will have access to those essential health services, and fund them through both private and public methods. With the essential benefit plan in place, the system could allow for the purchasing of additional benefits, if so desired, from the competitive marketplace.

But every person would have, as a starting point, guaranteed coverage for truly essential care.

 

4. Invest in the components of a health infrastructure (clinics, personnel, outreach programs, etc.) needed to assure that services exist where people live.

Similarly, we should invest in and pay for approaches that help us take care to the individual -- either in person or by means of technology. This would be particularly valuable for those with chronic illness trying to live at home, or people living in forgotten parts of our larger cities and rural locations.

 

Of course, there is more to it than these initial steps. We need to change our reimbursement structure. We must shift to a system that pays care providers for taking care of the individual rather than for each event and intervention, regardless of value or result.

 

It is essential that we develop better approaches to educating people on disease prevention and appropriate health interventions. But first we need a framework. This is not a call for a nationalized health system. In fact, it is an effort to avoid one, by intelligently and appropriately using our great health resources for all of our people.

 

Every nation is struggling with the costs of and outcomes from their health care systems. Yet many have realized great success, and from them we can learn much. For example, in the Netherlands a mandatory set of essential health benefits is now provided to all people through private insurers, with financial support by the government for those who are unable to pay even the relatively low cost of the basic program. Beyond the essential benefit set, individuals and employers can buy supplemental coverage of their choosing (and at their expense).

 

There is no reason we cannot be equally forward-thinking, nor is there any excuse for allowing our current state of affairs to exist any longer. If such an approach were used in our country, we could retain the participation of private insurance companies, but in a different, less intrusive and less costly role. We would foster competitive markets and ensure that basic health needs are met. And we would leave the option for people and companies to purchase additional services with their own funds.

Per capita costs could be a fraction of what they are today, with even better outcomes.

 

Our reform efforts should not be about advocating a liberal or conservative approach, or the ideology of public or private enterprise, or for-profit vs. not-for-profit business models. This is about realizing an undeniable end goal -- the health and well-being of each of our citizens.

 

It is the path that any enlightened society must follow.

 

 

William W. McGuire, M.D., is the retired chairman and CEO of the Minnetonka-based UnitedHealth Group.

 

(Note: This submission was originally published at Minnesota Public Radio Online on July 15, 2009)

 

 

 

Steve Bonner

The American healthcare consumer has spoken about the nation’s pathway to healthcare reform. First in Virginia and New Jersey, then in Massachusetts and now in a recent Gallup poll, Americans want Congress to put the brakes on its current healthcare reform efforts.  Everyone agrees that something must be done, but people want to control decisions about their healthcare.

People want more flexibility, choice and options. They don’t need government or anyone else to decide how and when to buy the healthcare they want. They are taking control in many ways. We’ve seen growth in healthcare savings accounts and more people are turning to the internet for information and advice. And people will go where they feel they will get the best care.

No longer will people only go to their neighborhood hospital for all of their needs. We’ve seen tremendous growth in medical tourism and patients traveling hundreds of miles to receive what they feel is the finest care.

But what Americans are hearing from Washington is "we'll decide this for you."  That's not what they want.  It’s not what anybody wants.  As consumers of healthcare services, we want a say in how care is organized, priced and delivered.

We need higher quality and lower cost in healthcare. We can look at every other high-quality, low-cost industry and see one consistent, simple factor at play: a fully engaged, active consumer teaching the providers what they value and what they will pay.

Take iPhones and Blackberries, for example.  How many of us had a Blackberry or an iPhone ten years ago?  Why do so many of us have them today? Because they help us live a better life and they’re available at a very attractive cost.  And they keep getting better: more functions – better quality – lower cost.  Doesn’t that sound like the American dream for healthcare?

The first iPhone was a pretty fundamental phone and cost almost $600.  A couple of years later you have a much more advanced phone with music, video and 10,000 applications, and it can cost as little as $99.  

How did this happen?  Did the government say “cut the costs?”  No.  Blackberry and iPhone compete with each other.  They want your business.  They study each other, they study you and they offer you more to get your business.  You buy, so they can be more efficient and the cost comes down…a lot! And the quality gets better and better.

This is an opportunity for more than reform – it is a time for a healthcare renaissance.  This is a time for us to listen to what consumers want in their healthcare – just like the makers of the iPhone and the Blackberry have - which should be the basis for individualized care.

As consumers, we can teach providers about what we want.  We can teach them what we will buy and won’t buy.  If they want our business, they get better and improve the price-value picture.   

In healthcare, insurance companies, HMO’s and the government decide where you will go, what you will buy and what will be paid.  These are people you will never meet and they are making some of the most personal and powerful decisions in our lives for us.  Why do we delegate decisions about healthcare to strangers…when we would not let them decide what car or phone we will buy?

Consumer-centric markets work.  Why not try consumer-centrism in healthcare? Why can’t cancer patients, for example, shop in a national market for the best cost-benefit value in oncology?  Will “health insurance reform” create a truly consumer-centric model for health care?  Is it now time for us to consider some new ideas? 

Let me share with you some lessons we have learned at Cancer Treatment Centers of America (CTCA) by listening to cancer patients.  The CTCA experience has become one of truly patient-centered and holistic care. And that’s why we are encouraged that a renaissance can happen. 

The CTCA model has been designed by cancer patients, through focus groups, surveys and walking around to talk to patients and care givers. Our model is truly holistic.  We begin with the very best traditional oncology: chemo, radiation, surgery.  Those treat the tumor.  

Then we add nutrition, naturopathic, mind-body medicine, exercise, spiritual support, acupuncture, pain management, laughter therapy, pet therapy…and on and on. We’ll do whatever it takes to lighten the load on the immune system.  We also rigorously apply LEAN and Six Sigma to eliminate wasteful processes, and improve quality and costs.

So as CEO of this unique network of cancer hospitals that puts patients first, I hope that together we can create a healthcare industry with a fully empowered patient at its center – and do so in a world where today, many healthcare decisions are being made by people the patient never even meets.

The national healthcare conversation started on healthcare reform and now it is on health insurance reform.  I think we are ready for this healthcare renaissance – a return to the fundamentals that guided this industry until World War II, now about 50 years ago, and that still guide all efficient industries in this country. 

As consumers, we all know how to do this!! It is time we demanded it of each other, for each other…and for a much “healthier” healthcare system.

 

Steve Bonner joined Cancer Treatment Centers of American in 1999 as president and chief executive officer.  He's been an outspoken leader and advocate for patient centered cancer care.

 

 

 

Congressman John Shadegg

Health Care Reform in Digestible Pieces

When was the last time you asked your doctor how much it would cost for a necessary test or procedure? In all likelihood, you can't remember. That's because your employer-provided health plan or the government "paid for it." In fact, you paid. We all pay for health care.

There's no denying that our health-care system is complex. However, we can trace most of the problems in the current system to the lack of control individuals and families have over their care. If there's one lesson we've taken away from the thousands of citizens at town-hall meetings, it's that one massive health-care bill isn't the solution. Americans nationwide have voiced their desire for greater control over their care and for reform in digestible pieces.

The political disagreement between Republicans and Democrats is not whether to cover everyone, but how to do so. The president and congressional Democrats say we should create a new government-run plan, outlaw the health coverage Americans enjoy today, and let federal bureaucrats control the content and price of health plans. Their bill, H.R. 3200, is filled with more than a thousand pages of new mandates, penalties, regulations and taxes. It is nothing short of a complete takeover of the entire health-care system by Washington politicians.

We believe that all Americans deserve the ability to select health-care coverage that meets their needs—not the preferences of politicians. Republicans in Congress want to empower Americans to make their own choices by providing a dollar-for-dollar tax credit for you to purchase the plan of your choice.

If we give citizens the ability to control their own care, cover pre-existing conditions, and provide resources to the uninsured, we will have fixed health care in America. No bureaucrats. No new czars. No mandates. Just choice and coverage for every American.

Read more at: http://online.wsj.com/article/SB10001424052970204731804574390683768374864.html

 

 

John Shadegg was elected to Congress as part of the Republican Revolution in 1994 and represents the 3rd Congressional District of Arizona.  He has introduced legislation to promote patient choice, individual ownership, and portability in health insurance. His two bills – the Patients Health Care Reform Act and the Health Care Choice Act – offer comprehensive, free-market solutions to the rapidly rising cost of healthcare by allowing individuals to choose a health care plan that best meets their needs.

 

Karen Ignagni

Payment reforms, along with performance measurement, are fundamental building blocks of health care reform. These reforms will transform our health care system into one that pays for value instead of volume and improves quality and safety of patient care.

Almost a decade has passed since the Institute of Medicine (IOM) issued “Crossing the

Quality Chasm,” its landmark report that found our health care system does not consistently provide high-quality health care to many patients. Despite the IOM’s urgent call for change, wide variations in care across the country still exist, and significant resources continue to be spent on sub-optimal care. Poor performance in our health care system costs the nation up to 79,000 avoidable deaths, 66.5 million sick days, and $1.8 billion in excess medical costs each year.

As our nation faces the growing burden of health care costs, health insurance plans are delivering new payment models that are showing results in making the system more affordable and improving value and safety. Some are being explored in the context of broader efforts such as the patient-center medical home, one model that health plans are advancing, in collaboration with other health care stakeholders, to improve quality and coordination of care as well as to engage patients in their own health care. Health insurance plans have been at the forefront of efforts to pay not just for services rendered, but for outcomes achieved through new payment policies that recognize and reward quality performance. A 2006 New England Journal of Medicine article reported that at least half of the nation’s health insurance plans, representing 80 percent of all enrollees in such plans, included some quality performance incentives in their provider contracts. Of those, 90 percent had programs for physicians and 38 percent had programs for hospitals. For patients, this progress means greater safety and improved outcomes. For providers, it means being recognized and rewarded for practicing to the highest professional standards.

As policymakers continue to propose various reforms, health plans remain committed to pioneering the types of innovative approaches necessary to move to a 21^st century, evidence-based health care system, regardless of what reforms are ultimately enacted.

 

 

As President and Chief Executive Officer of America’s Health Insurance Plans (AHIP), Karen Ignagni is the voice of health insurance plans, representing members that provide health care, long-term care, dental and disability benefits to more than 200 million Americans.

 

Ron Wince

Ownership is the Key to Improving Health Care

As a small business owner providing coverage to my co-workers as well as a consultant to the various players in the health care industry I have seen firsthand the impact of not including the individual at the center of health care and health care reform.   Waste and cost continues to explode despite the focus on efficiency, fraud goes unchecked with little sign of being harnessed, and only incremental improvement in quality.  All of this takes place in a system where patients are told which providers they can use, where they can purchase insurance coverage, and from which pharmacy they must buy their medications.  And as the debate over reform rages on the same thinking that created the system we have today is the same thinking that underlies many of the reform options on the table – that experts and/or bureaucracy is the best way to improve care, drive down cost and increase access to care.

But true reform must come from new thinking and new perspectives.  Thinking and perspectives that only patients can provide. Only patients can partner with their primary care giver to make decisions which serve their particular condition best.  Likewise, only patients can determine which form of insurance coverage best suits their unique situation.  And only patients, behaving as individual consumers as they do daily other aspect of their lives, can refuse to pay for waste and unnecessary care; avoid doing business with those who perpetuate fraud and abuse; and determine for themselves which caregiver provides the best service at the lowest cost.   Then and only then, when patients are equipped and enabled to behave as consumers, can we begin to see the health care system change.

Many would have us believe that shifting to a consumer centered model would be difficult.  Nothing could be further from the truth.  The individual U. S. consumer is the smartest, most capable being the world has even seen.  The only difficult part is a willingness to equip patients to behave as “owners” of their own care and care decisions.  Fortunately equipping patients needs not be overly complicated:

1.    Patients must have access to information which is understandable and actionable.  Today most individuals have access to better information about buying an automobile than they do about their own medical history or the cost and quality of their primary care physician.  Interestingly enough the information exists and is accessible.  Payers, providers, and even the government have access to the information most people need to make good decisions and become good consumers.  That same information must be made available in a usable form for patients to equip them to make good “purchasing” decisions.

2.    Every individual must learn to make health care decisions.  Just as students in elementary school can learn math and science every individual can gain access to the education they need to understand health and health care.  Much of what is needed is already available and in a form which can be understood by every patient.

3.    Lastly, patients, like every other consumer, must be afforded the ability to speak with their wallets when they have made a “buying” decision.  Today the constraints – both intentional and unintentional – prevent most patients from participating in many of the decisions about their own or a family member’s care.  Once patients can freely choose from any payer, provider, and pharmacy we will begin to see the true power of consumerism and individual centered care.

Without question there is momentum to reform the system of health and health care today.  But focusing on only one aspect – such as payment reform – and excluding the individual from the discussion and development of a new approach to health and care will be like moving the deck chairs on the Titanic.  True reform can only be achieved when we empower individuals to behave as owners of their own health and health care.

For more information on "Guidon Performance Solutions" visit http://www.guidonps.com.

Co-founder, President and CEO of Guidon Performance Solutions, LLC, Ron Wince has nearly two decades of experience leading performance improvement and cultural transformations within manufacturing, service and government organizations.

 

Lynette Bisconti

Healthcare should be about results – not predetermined or preapproved protocols and activities, but real results that are important to the individual. 

I’ve heard a lot of people say that most patients don’t understand, or can’t understand the complexities of the healthcare industry - including their own health management. If that is the point of view of the medical community, it’s no wonder that patients are being ignored or left out of the equation. The fact is we can make decisions for ourselves and we want to make decisions for ourselves. I know this, because 12 years ago I took control of my own healthcare and that is why my son and I are here today. 

Just three weeks after learning I was pregnant, I was diagnosed with breast cancer. In those early days, I knew instinctively that the biggest difference in my ability to survive cancer had nothing to do with a drug, surgery, or doctors. It had nothing to do with cancer or my pregnancy. It all started with me. And while I knew it all started with me, I quickly discovered that in today’s healthcare system, no one else thought it started with me.

So I began my journey to find patient-centered and individualized care. To beat cancer, save my baby and have a quality of life on par with what I had before cancer, I needed to be actively involved in decisions about my medical care.

These were my life and health goals – individual to me – and I needed my care team to understand what I valued most, to listen to me and respect my decisions about my cancer treatment. I’ve had the privilege of speaking to hundreds of patients, many of whom never knew they could take control and advocate for themselves, or for that matter have any idea how to do it. Why should anyone think they need permission to be in charge of their own life and health goals?

During my journey, I sought a total of eight medical opinions, not because I was in denial, but because each of my first six opinions treated me as if I were part of a protocol. Cancer is a disease that can take complete control of your life. It takes control physically, mentally, financially - every part of your life including your family is affected. My journey taught me that I am in control of my life and health goals. Once I had control, I had hope...again.

Unfortunately, our current healthcare system has trained us to follow – not take the lead. We all agree that our current healthcare system is painfully broken and that real change is vital to the future success of medicine in the U.S. Our opportunity to create real change begins with individualizing our approach to care. That means aligning the expectations of patients with how services are organized and delivered. The only way to treat and heal individuals - and treat and heal our healthcare system - starts with patient-centered medicine. Our opportunity to create real change begins with laying a foundation of patient empowerment. It's a realization that there are two experts in the room - one is your medical expert, but the other is YOU.

Patients – all kinds of patients – need to be at the table. Their values and views must be the center of this discussion. To decide what to offer your customer without asking them what they need or value will doom any business. Why should we expect anything different from our healthcare system? We must expect and demand more from them and for ourselves. Healthcare doesn’t work if those receiving care aren’t at the center.

 

Lynette Bisconti

Patient Advocate

President, The Gateway for Cancer Research

 

Michael Fleming, M.D.

In order to create a healthcare environment that saves lives while saving dollars from the current system, we must have a healthcare system that focuses on outcomes, not costs. The best outcomes occur when both providers and consumers have a consumer’s mentality: that is, are knowledgeable about quality, are aware of the limitations of healthcare, and use that knowledge in making healthcare decisions (note that I included both providers and consumers in that decision-making).

 

First, alignment. Most of the chronic diseases that plague us are preventable. This will require changes in lifestyle, changes in culture and changes in behavior. If we do not accept and adopt these changes, what price are we willing to pay? Incredibly, Medicare did not even have a preventive benefit until 2006. That’s because when Medicare was begun in 1965 the most common causes of death were acute events and infectious diseases – heart attacks, strokes, pneumonia, sepsis, etc. It was a “treat and cure” system. But in the 21st century the most common causes of morbidity and mortality are chronic diseases – diabetes, obesity, hypertension, heart failure, cancer. Many of the latter are preventable and curable when detected early. Most of the former are chronic illnesses that can be managed. So what we really need now is a “prevent and manage” system.

 

Second, information sharing. How is it that there is more technology in use in my local grocery store than in most physicians’ offices? Information is power, and in healthcare it is the power to make good decisions. Just-in-time information is now available with a click of the mouse – if your provider has an electronic medical record (EMR). Your entire health history can be available on a card or flash drive in an instant, and could save your life if you require emergent care – if you and your provider keep your personalized record up to date. That same history could be available to any emergency department in any hospital anywhere in the world – if your provider has an interoperable system. So if we can, why don’t we?

 

Third, patient-centeredness. According to the Institute of Medicine patient-centeredness is one of the six characteristics of quality healthcare. And as much as we hear this word used now by providers, I don’t think we really mean it. Our system and every player in it demands that you, the patient do what WE want you to do, when WE want you to do it, where WE tell you to it. That’s the antithesis of patient-centeredness, and yet on it goes. Every single person deserves to share in making healthcare decisions that affect them. And that leads to….

 

Finally, coordination of care. Our Medicare system currently spends 69% of the total spent on just 12% of patients. These are the patients with chronic diseases who require more care, and yet who we seem to do less for. Many of these patients can be successfully managed if their care is coordinated. Not episodically factored, not driven by emergency departments, but managed by caring providers whose special calling it is to care for the most frail and vulnerable. But the care for this 12% is just as fragmented as that for the younger and healthier among us. Quality providers – nurses, therapists, doctors – can care for these patients in a safe environment and manage their chronic problems by coordinating their care. The industry that specializes in this segment is home health care, and the quality improvements and cost savings have been demonstrated to be remarkable.

 

You’ll note that nowhere in the four tenets above did I speak of spending more. Instead why don’t we think of reallocating dollars in a sensible fashion and focus on quality rather than dollars.

 

 

Michael Fleming, M.D., joined Amedisys as Chief Medical Officer in 2009. Dr. Fleming brings more than 39 years of medical field experience to his new position. He is past President of the American Academy of Family Physicians and the Louisiana Academy of Family Physicians; and is founding President of the Louisiana Health Care Quality Forum, a partnership with the State of Louisiana aiming to provide high-quality health care to the state. Dr. Fleming has served as Speaker of the Congress of Delegates of the AAFP and as Board Chair of the AAFP Board of Directors.