After the scene-setting from Dr. Cortese and Korsmo, a panel discussion ensued, in which they were joined by Congressman Ron Kind, who represents western Wisconsin in the U.S. House; Mary Jo Werner (with the Wipfli accounting firm), and Rusty Cunningham (Publisher, LaCrosse Tribune).
Congressman Kind raised concerns about IT innovation, which is exciting, but said proprietary interests are being built into competing systems. The systems need to be interoperable…they need to talk to each other, making information available to patients but also protecting their basic privacy.
Werner, a partner in a CPA firm, said the issues are transparency and accountability. Entitlement isn’t appealing to a business owner. There needs to be an ownership interest in their own health care among employees, so they have economic incentives to take care of themselves.
Cunningham described the people in the room as “partners” and said there is a great spirit of cooperation within the community. They have promoted many health and wellness community collaborations aimed at weight loss, smoking cessation and other healthier behaviors and lifestyles. He suggested looking for ways to bring health care professionals and patients together as a team on a more collaborative, group setting instead of sending patients from one specialist to another. Instead of just creating teamwork among providers, involve patients in the team.
In response to a question on paperwork reduction, Korsmo said Mayo has a large group of people devoted to interpreting thousands of pages of Medicare reimbursements, while contracts with private insurance companies are typically just a few pages.
Rep. Kind says a barrier to moving toward individual ownership of health care is fear of the unknown, because people are accustomed to their employer-sponsored insurance.
Dr. Cortese says the major barrier to getting some of the reforms Cunningham suggests is that “nobody pays for it.” The financial incentives are all wrong. High relative value is paid for specialists, while primary care is underpaid. Right now you only get paid if the patient comes to the office. Virtual consults and team interaction outside the office require significant payment reform.
For example, Intermountain Healthcare manages 25,000 diabetics with four endocrinologists. Success is when people don’t need to come to the office. We need to find ways to reward healthier behaviors and systems that reduce utilization.
Dr. Cortese says The Commonwealth Fund has done a report that highlights six states that outperform all European countries. Wisconsin is #1 in some categories, Minnesota in some others. There are about 15 states that are comparable to the European systems. Elsewhere in the U.S. the problem is the culture in the physician communities, where people aren’t accustomed to work in teams.
In response to a question about whether costs could actually be reduced, Dr. Cortese said “that’s what value is all about.” He says the top five disease account for about 60 percent of Medicare costs, and these are typically chronic conditions. Finding ways to manage these conditions more efficiently in a team environment could lead to significant savings.
At the end of the event, the participants voted again on priorities, on a scale of 1-10:
- Payment reform got an 8.6
- Universal Clinical IT an 8.4
- High-Cost Service Programs – developing programs for managing these chronic conditions – an 8.7
- Care Coordination – 8.6
- Benefits to Improve Health – defining minimum standard benefit packages to improve health in addition to treating disease – 8.6
Please add your comments and ideas below in the comments.
