Mayo Clinic, Kaiser Permanente and Intermountain Healthcare have worked collaboratively to publish a white paper Delivery System Reform: Action Steps and Pay-for-Value Approaches. As three leading health care organizations, they set forth a set of principles and characteristics they believe all health care organizations should strive to achieve. Read the paper.
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Bravo on your approach to health care reform. We have come to virtually identical principles to health care reform from an entirely different process.
We are a grassroots organization that grew out of a “Build An American Health System” contest in 2003. Emerging from that grassroots contest, we come to these same principles–patient-centered health care; shared decision-making; choice; shared responsibility; teamwork; and evidence based medicine.
We have tested and tested these findings over the past five years–online surveys, collaboration with other nonpartisan, nonprofit partners, market research surveys, and we keep coming back to these same conclusions.
We think these points are something the public would support and are hopeful we can move health care reform along by partnering with like-minded groups and build on the common ground and consensus that does indeed exist.
Kathleen O’Connor, CodeBlueNow!
Three principles should govern health care reform: (1) Health care providers should profit from good practice, innovation and efficiency. (2) Patients should have free access to health services. And (3), everyone should help pay for health services.
The fairest, simplest method for financing health care is through the existing tax-collection system, combining a flat payroll tax and a national retail sales tax on goods and services.
A Federal Health Preserve, modeled after the Federal Reserve System, should manage health services and establish fiscal and professional accountability in health care. The Federal Health Preserve would be an apolitical, independent governmental agency staffed by health and health-care professionals. It would set national health policy and goals, monitor and regulate health services and clinical research, establish peer-developed national health-care standards, set health services that everyone is eligible to receive, and determine payments for services. The agency would report to Congress and negotiate an annual budget to pay for necessary health services.
By itself, Congress cannot reform health care. Its approach is typically piecemeal and subject to crippling compromises. A nonpartisan commission should be established to develop a vision for health-care reform, enabling legislation, and an implementation plan.
Simply taxing everyone and making health-care free does not fix anything except to guarantee that health-care professionals are paid on time. Here’s what we really need, from a patient point of view:
1. More Doctors. We have a supply vs. demand problem. Start medical training earlier (like high school), and ease up on the ridiculous hours that tax med students to the point of failure. Allow more students to apply to med school.
2. Help for those who can’t afford healthcare. Full payment for critical care. Partial payment for non-critical care with patient paying the balance.
3. Mandates for healthy food. For example, gradually increase the amount of whole grain required in cereals, breads, cakes, crackers, pancakes, bagels, doughnuts, and all other grain products until after 5 years these products contain at minimum 50% whole grain. This will increase the vitamins, minerals, fiber, protein, micronutrients and lower the glycemic index to reduce the insulin response. Also, our livestock needs to be better fed. Cattle need mostly grass, not corn. Pigs and chickens need a huge variety of foods, not just corn and beans. Healthy livestock means healthy food (pigs fed distillers grain have more unsaturated fat than corn-fed pigs). Overall this will vastly improve the average American diet and help stem the increase in obesity and its related health problems.
4. Large medical institutions need to stop building monuments to donors. The Mayo Clinic’s Gonda building is so expensive the cost is not published online. Too bad all that money didn’t go directly to real healthcare instead of frivolity such as ‘Clad with white Brazilian granite in an innovative curtain wall framework of brilliant, linen-finished stainless steel and set on a base of white marble’. It’s no wonder healthcare is expensive with buildings like that.
5. We need distributed healthcare, not giant facilities in few cities. More Doctors (number 1) would make this possible.
6. True torte reform. Health-professionals need to be accountable, but not to the tune of millions of dollars per patient. How about just a double refund of all incurred expenses? A decent term-life insurance policy should protect the patient for really nasty things, like losing a limb or one’s life.
THE PROBLEMS WITH HEALTH INSURANCE
Health insurance’s problems preclude it from being part of reformed health care.
For starters, the goals of health care and insurance are antithetical to one another. Health care’s goals are the long term protection and improvement of health; commercial insurances’ goals are protecting profits, necessarily short term since policies are annually renewable. Pursuing profits, insurers use strict underwriting practices and develop complex bureaucracies to deny or delay approval of services.
And insurance profits and standard industry costs for underwriting and managing access to services, marketing, sales commissions and bonuses do not meet the pale of legitimate health care costs.
But illegitimate insurance costs are only a portion of insurances’ burden on health care costs. Some 1500 health insurance companies, with 1500 bureaucracies, sell thousands of health plans. Health care providers must find (uncompensated) ways of dealing with the costs resulting from this maelstrom.
Primarily due to insurance-related problems, the health care environment is toxic. Professional morale is low, service and quality are uneven, costs are high, and outcomes are disappointing.
In health care reform, insurances could serve as fiscal intermediaries, audit for fraud and abuse and providers’ adherence to peer-established standards of care. But health insurance should not be involved in financing and managing access to health care.
Jim Waun, MD,MA,RPh
Feb 9, 2009
Dr. Waun:
Thank you for participating in the Health Policy Center blog. I am one of the moderators.
I am curious as to your thoughts regarding the proposed U.S. Health Board that is being discussed. Is it possible that such a Board could provide some oversight and set some standards to mitigate some of the problems you describe above?
Some of the tasks/duties that we see a U.S. Health Board potentially taking on include:
o Simplifying administrative activities
o Facilitating a functioning insurance market in which no patient is excluded and which appropriately distributes the risk of insuring people
o Defining how to measure the results of care including outcomes, safety, service, and the coordination of health care and services
o Identifying providers who achieve the best results and developing new payment models that allow providers who provide better results and better health to flourish
o Certifying the accuracy of metrics for outcomes, safety and service
o Creating, maintaining and disseminating medical evidence
o Planning for the future medical work force
o Reporting safety problems, medical errors and waste
o Arbitrating medical-legal disputes
I would be very interested in your thoughts on this.
Thanks!
Mr Denney:
Thank you for participating in the HPC blog. I am one of the moderators.
Your comments about the need for more physicians, distributed care and torte reform are very interesting. We have heard similar concerns, particularly in the ability of patients to access primary care with fewer physicians choosing primary care as their specialty.
You may be interested in the Medical and Health Care Education Symposium that we are holding in April. Check it out at http://www.mayoclinic.org/healthpolicycenter/2009-education-symposium.html.
Jane Jacobs
Mayo Clinic Health Policy Center
Ms Jacobs:
I believe that the U.S. Health Board functions you’ve described fit what I have in mind with a Federal Health Preserve (FHP) quite well, but not perfectly.
Would the Board be apolitical and independent, or subject to control/influence/budgetary restrictions from either the executive or legislative branches of government? The FHP would be both apolitical and independent.
As I briefly described in my last blog, the indemnity insurance model for financing and managing access to health care, and payment for goods and services, has inherent conflicts of interest that cannot be reconciled and will only worsen. Our 70 years of experience with health insurance, culminating in the Medicare Drug Program, is final proof that insurance can’t function along with health care in a “free” market.
Reformed health care should be accountable to the American people both professionally and fiscally. Fiscal accountability comes in the form of an annual budget that the FHP would negotiate with Congress; professional accountability comes from setting national health care standards and auditing providers for adherence to them. The FHP would have the necessary authority to sanction substandard and/or fraudulent practice.
The FHP would also have the authority and responsibilities of monitoring patterns of health care errors and mistakes, investigating them, and adjusting their standards of care accordingly. The NTSB and FAA have long track records in those functions and could serve as additional models.
I completely support the rest of the U.S. Health Board proposal.
HEALTH CARE FINANCINGA fair and stable system of financing health services will be a crucial element in health care reform. The current financing method, involving mixed funding from employers, governments, and individuals, cannot be either fair or stable for several reasons. Paying for employees’ and their dependents’ health care is not a legitimate cost of doing business. The current form of governmental involvement in paying for health care involves controversial sets of qualifications and expensive bureaucracies for implementing them. And it invites cost shifting that isolates individuals and strips them of negotiating power in the health care marketplace.Fair and stable financing for health care would be part of a fraternal twin, transparent system of fiscal and professional accountability. The system would have a budget, national standards of care, and be audited for performance, fraud and abuse. The simplest and fairest method of establishing stable health care financing would be for the health care system, as a whole, to negotiate a global budget with the federal government to pay for necessary health services. The federal government would distribute health care costs by levying a flat tax on income and consumption. The government should pay for, but not control, manage, or directly deliver health services. Health services should be delivered by a private health care system with incentives for efficiency and innovation, and monitored and regulated for quality and outcomes.
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A DRASTIC MAKEOVER FOR MEDICINE
Health care reform ought to include incentives for transforming medicine to fit the health care needs of the twenty-first century. From antiquity, medical practice remains essentially unchanged. For the most part, health care providers practice in individual silos. Communication between silos, when it occurs, is often slow, sketchy, and oriented to the management of diseases rather than the needs of patients as persons. It’s left up to patients to cope with the vagaries of this “system.”
If health care reform is going to produce better value, the silo scheme of health care delivery will have to be replaced by a system of health care teams that assimilates patients and interdisciplinary health care providers into microcosms for health improvement and maintenance.
As teams’ executive leaders, physicians will need skills in organizing and supervising groups, diagnosing functional dis-ease, and working collaboratively to resolve it. The necessary body of information for training them already exists in industry, waiting to be transcribed for health care and incorporated into modules of medical and post graduate physician education.
The body of information includes designing, nurturing and incorporating compensation incentives into high performance work systems, understanding organizational psychology, promoting communication and continuous evaluation and feedback among team members, and diagnosing sources of tension and conflict among team members and devising decisive measures for conflict resolution and reconciliation.
Health care will have to be more cost effective and produce better outcomes. Medicine needs to grasp the concept of health care teams and utilize incentives for reform.
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