Panel Discussion: Health Care Policy: Will Reform Become Reality?
Panel Moderator: Michael Conway, Moderator, Director, McKinsey
Panelists:
Dr. Steven Udvarhelyi, Senior Vice President and Chief Medical Officer, Independence Blue Cross
Kevin Gorman, Managing Partner, Putnam Associates
J. James Rohack, MD, President Elect, American Medical Association
Len Nichols, Director, Health Policy Program, New America Foundation
Key Themes:
- Increase access to care
- Realign incentives – difficult but necessary
- Health IT will play a large role in changing the industry
- Increase investment in preventative care with physician in the equation.
Summary Notes:
What is your proposal for Health Care Reform?
J. James Rohack, MD – President, AMA
Cash, Choice, and Change.
Cash – tax credits to individuals purchasing health insurance.
Choice – addressing their medical needs.
Change – current waste in the system; reducing the redundancies that add no value.
Steven Udvarhelyi, MD, Senior Vice President and Chief Medical Officer, Independence Blue Cross
Sustained balance. A delivery system and cost containment. Cost reduction in the system. Reform needs to include all the players in the system. For example, reform that allows people to opt out of health insurance will fail since it leaves out the payers.
Why are we screening 50% of those at risk for colon cancer when it costs four times as much to treat than to screen?
Kevin Gorma, Managing Partner and Founder, Putnam Associates
Bio pharma wants to increase access to care.
FDA reform
- Leadership; need one consistent head of the organization
- Funding
- Staffing
Preserve Medicare Exemption for Part D.
The $1.1 Billion on Comparative Clinical effectiveness is a concern. Good data is essential, but how will this data be used? We are concerned that there will be a government mandate on pricing about which industry will have no choice.
Do you have any advice for President Obama on what to afford?
Len Nichols, Director, Health Policy Program, New America Foundation
Economists have similar requests as the AMA, Hospitals, Industry – we would like to expand coverage, improve the delivery mechanism, and most of all realign incentives.
The system should stop thinking in silos and align interests.
1% of the GDP (2008) could cover all of Americans. People think that 1/3 of health care spending offers no clinical value. If 16% of the GDP is spent on health care, and 1/3 of it is of no value, then approximately 5% of the health care expenditure is waste. If we get 20% of the waste out of the system, we can afford more care for more people.
Today a higher percentage of American’s income is going to health care. It used to be 7%, and now it is 17% of our income. It is no wonder that both political parties were so focused on this issue.
The amount of money that will be spent is not the issue; aligning interests, on the other hand, will be difficult.
There are 42 million uninsured and 40 million people that are underinsured. As we start to provide coverage we will reach a limit to resources, both capital and human, to get the job done.
J. James Rohack, MD
It takes seven years from the time someone starts medical school until the time that they can provide care. Even if there is coverage for everyone in the US, there will be a bottleneck for providing care.
There is inefficient and expensive delivery of care to the uninsured population – through the ER. If the US can provide a market based solution to this problem, there will be large savings. If PCP’s were paid to coordinate work, IMS would consider seeing uninsured patients.
There distribution of physicians is: 70% specialists and 30% Primary Care. We need to think how we value Primary Care and coordination of care. The system doesn’t value a patient’s need for someone to listen, which is free. There is a knee-jerk reaction to write a prescription or recommend a device.
Steven Udvarhelyi, MD
The US does not have adequate supply of Primary Care physicians; however it does have adequate capacity in hospitals and specialists
In 1994, a heart transplant center that performed less than 9 transplants a year had 4 fold higher mortality than a center with higher volume. Consolidation of centers could cut mortality in half.
The problem is not just access to care and incentives to providers, but incentives to citizens to live a healthy life style and practice preventative care.
How will Health IT impact the system?
Len Nichols
The infrastructure of the system should enable the doctor and the patient to share best practices, including a full medical history, and full knowledge of treatment options. The system should allow better incentives, comparative metrics, and link incentives to information flow.
Government has done a good thing by stating that it will only reimburse HIT integrations that are interoperable.
J. James Rohack, MD
The data shows that 60% of care is delivered by solo practitioners and group practices that have fewer than 3 physicians. These groups will not adopt EMR systems. Physicians were the first to adopt pagers, cell phones, because they allowed physicians to treat their patients faster. Physicians will adopt technology if it makes sense and adds value.
EMRs have not been widely adopted because they do not talk to each other. The majority of the money should be spent on interfaces.
The concern is for privacy. But right now the most secure patient record is a rubber band on top of a manila folder that only a physician can read because of the poorly legible physician handwriting.
Steven Udvarhelyi, MD
Physicians, hospitals, clinics are businesses that need to thrive. They must invest to stay competitive and IT is one of the criteria for staying in the business.
The manila folder does have risk of privacy breach, but there is little incentive for anyone to break the record. Once data is aggregated online, there will be breaches. The risk is higher.
There will be patches and we will figure out solutions, but privacy breaches are inevitable.
Chronic diseases are a huge driver of cost. How can the CMS and government play a role in addressing chronic diseases? Pilots in preventative medicine have failed to achieve endpoints in improving chronic disease.
J. James Rohack, MD
The preventative care studies were done by disease management companies. They provided a service of phone call reminders to take medications. If a patient was sick, they would often send them back to the system through emergency room actually adding to the expense.
The person that needs to manage chronic disease is the physician that holds the patient relationship.
This type of study will have better outcomes. Patients and physicians need to be incentivized for this study to work.
Len Nichols
If you design bad studies, bad stuff will happen. Physicians need to be included in the equation. Studies have shown that the more time physicians spend with their patients, the better the outcomes. ER visits and morbidity decrease. If there was a health plan that reimbursed appropriately for 40 minute physician visits, outcomes would improve.
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