The following questions and comments were submitted during the Monday morning session on Cornerstones of a New Approach. Click the Read More link below to see the full list.
• “Choice” has become a myth for most Americans. Most Americans with insurance have become accustomed to being “in=network” which is not unlimited. So our “choices” are actually limited….how would that be different if implemented in a single payer system?
• Dr. Neilson: Candidly, are doctors frustrated enough with the current system that they are finally willing to give up some autonomy, some freedom of action, their comfortable routines in order to be part of a coordinated care system?
• Can someone address the need to reduce non-value added cost of care such as the insurance company profits?
• What about the spiraling costs of out of pocket costs for people with a chronic disease?
• How do we keep the consumer from being the ‘payer of last resort?’ In my experience my private insurance and Medicare at times are at odds and neither want to pay for my care and services.
• Can the speakers reflect on how we can better integrate clinical research into the delivery system (ie, telling patients about clinical trials, pooling adverse event reporting, quality measurement, community wide health status, etc.)?
• If access to medical records, coordination of care, and provider communication can be accomplished through electronic communication tools, guidelines, and standards does care really need to be under “one roof” in our flat world?
• Everyone is talking about how personalized medicine is nearly here, will our current system really be able to handle it and utilize what these research advances may offer?
• To be able to coordinate care and have transportable records, a core requirement will be a personal identifier (ID). Are we ready to accept that in this country?
• Why is “single payer” such a dirty word? Isn’t their a lot of waste in all of the marketing and ‘customer service’ or lack there of with all of the various insurance plans?
• If we are talking about working as a collaborative team- (patient, medical team, health plan) then shouldn’t the patient be given a copy of all of their records? What if each patient is given a flash drive and at each visit their tests, and consultation with doctors is recorded to it?
• A lot of our national discussion continues to be very focused on a sick care system. How do we move toward a “health” system focused on prevention.
• Regarding the as-yet-undone but so necessary “science of healthcare delivery” — who should do this? AHRQ or what other entity/agency? Who should pay for it?
• How do you pay for value? What does it look like?
• It has been said that we must practice evidence based medicine. I have an orphan disease. We must address how to practice when there IS no evidence, and how we advance the science in that situation. I am covered by the Federal Employees Health Benefits system, and it has not addressed these issues to my satisfaction. Please discuss options you see to address this conundrum.
• Do you really believe people entering health care professions today “don’t want to work as hard”? If so, does that mean “easy” is a necessary criterion for any successful reform?
• Why do we “pay” nurses, plumbers, lawyers, etc and “reimburse” physicians and hospitals?
• Who will take the lead to change the reimbursement system to start all of the other processes to drive care coordination? Is it the government or private payors? What will it take to get the private payors to move in this direction?
• How can consumers make pricing decisions when the costs they pay are significantly different from what insurers pay?
• What if fuller knowledge of costs leads some patients –especially the chronically ill– to forgo some medically necessary treatments because they perceive them to be too expensive? Might this not be particularly problematic when such decisions lead to much greater long-term costs?
• In a volume adjusted payment system how do you reward efficient providers? The current Medicare payment system for docs rewards the inefficient.
• The federal government is making so little progress on standards for health information technology, yet there is such opportunity to reduce waste and coordinate care through IT. Should we just let the private sector take charge of creating a national medical record system?
• Dr. Shortell, is there enough waste in our current system to, if eliminated, allow us to achieve universal coverage, value based, without spending any more money (or less money) than now?
• Dr. Berwick, you launched the 100,000 lives campaign as a way to use market forces to publicize the need for patients to consider safety and to become an active consumer of health care. What were the results of this effort in your opinion?
• Is pay for performance an efficient way to control cost and ensure value?
• Meaningful coordination of care requires time and effort on the part of providers. It will not happen automatically through electronic medical record availability. Yet there is negligible payment for this work. What can be done to provide payment for this critical aspect of what is good for the patient?
• how can prevention and disease management be encouraged through payment reform?
• Who should pay for comparative effectvieness, process research, and clinical research? Should it be the federal government?
• What kind of role do you see for family caregivers as part of care coordination team? Caregivers are particularly important members of the team especially for people with cognitive impairments and other disabilities who can’t self manage their own care.
• Do you feel a program whereby incentives (rebate of unused premium) combined with education protocol (internet based) that helps address the indiviuals needs and barriers can evoke behavior and responsibilty change?
• We have discussed the patient’s role and responsibility. The patient’s knowledge of value, payment, etc. varies according to their own resources, culture, and so forth. Who is responsible for educating the patient?
• Will the need to reduce the cost of healthcare advance the debate around people being given the right to determine when they will end their own lives in a patient centric system?
