Health Policy Blog

This session reviewed the work of the Mayo Clinic Health Policy Center over the last four years, in developing key principles for health reform.

The first of Mayo Clinic’s policy forums came dealt with Coverage for All, solving the problem of the uninsured. Representing those who participated in that forum were:

• John Rother from AARP
• Linda Dillman from Wal-Mart
• Michael Cascone from Blue Cross Blue Shield of Florida.
• Ashley Thompson from the American Hospital Association

Coscone said he would support something like the Federal Employee Health Benefit Program being made available for all Americans. Rother said one of the myths of Medicare is that it covers everything; most people need to buy supplemental coverage. Coscone said the lack of choice in most health plans contributes to people not being educated about their health care plan. With the FEHBP, people get accustomed to making some decisions because they have to make choices. You can see the summary about the policy forum dealing with the uninsured here.

Update: Here is the audio file from the Insurance for All panel.

The second policy forum was on Coordination of Care. Representing that forum for the recap were:

• Don Berwick, M.D., from the Institute for Healthcare Improvement, who said $600 billion is being wasted each year because of uncoordinated care.
• George Isham, M.D., HealthPartners, said one of the key priorities is health literacy. Need to encourage patients and doctors to connect in plain English. Medicare should set a standard of asking every patient whether they think their care is coordinated or not, and this should be publicly reported.
• Nancy Nielsen, M.D., Ph.D., from the American Medical Assocation, said doctors need to be trained and have the technical infrastructure to provide the complex, specialized information they need at the point of care. They can’t possibly hold all the information they need in their heads. We don’t need as many beds as we used to.
• Andrew Mekelburg, Verizon Communications – “If L.L. Bean can remember what color sweater you bought last year, you shouldn’t have to fill out the same forms each time you visit the doctor.”

Update: Here is the audio file from the Coordinated Care panel.

Representing and recapping the policy forum dealing with Value were:

• Stephen Shortell, Ph.D., University of California-Berkeley, who said it’s way past time for value-centered reforms. The inherent fragmentation of the system must be resolved, to create accountable units that mimic some of the characteristics of the Mayos and Kaisers. It will do us no good to expand coverage and put the money into a system that is not performing well. We need incentives to choose the most cost-effective delivery systems.
• Larry Harrison, Scripps Clinic, says we need both transparency and tort reform. “We don’t really have a health care system; we have a health care federation.”
• Randy Moore, M.D., American Telecare, Inc., says we need to look at segmentation. The top 5 percent of people use 50 percent of the dollars. These people (and our society) will benefit the most from coordinated care. “Any hospitalization should be seen as a sign of failure unless proven otherwise.” For others, who aren’t chronically ill, we need more accessible, convenient care.

Update: Here is the audio file from the Value panel.

Finally, representing the Payment Reform policy forum were:

• Nicholas Wolter, M.D., Billings Clinic, says we need to stop paying based on the volume of procedures. System fragmentation extends to insurers, which complicates billing.
• Joe Antos, Ph.D., American Enterprise Institute, says it’s essential for patients to know the costs of procedures so they can help evaluate their worth.
• Michael Morrow, Blue Cross and Blue Shield of Minnesota, says about 10 percent of what they pay is related to cost shifts due to government underpayment. We need to let innovation bloom so we can try new models of payment to see what works. Don’t just pay for a lab test on a line-item basis; pay for overall treatment of a condition.
• Clarion Johnson, M.D., Exxon Mobil, says he is charged with reducing expenses and protecting quality. It can be done.

Update: Here is the audio file from the Payment Reform panel.

As Brokaw opened up the discussion to all 16 panel members and the audience, here were some of the highlights.

Dr. Nielsen says society doesn’t pay for primary care and coordination of care. Doctors don’t feel they have any autonomy because of government and payer restrictions.

Frankly, Brokaw kept the pace of the discussion moving rapidly over the last few minutes; it’s impossible to adequately summarize.

But Don Berwick closed with a great statement:

“I’ve never been in a room before where people could really change health care in America. Until today.”

Check out the full video archive of the session here, and add your comments below. What do you think?