Do Over !!!!

We’ve obviously been asked about our reaction to the procedural vote that took place on Saturday to allow debate and discussion to proceed for HR 3590. In a nutshell- we’re very concerned.

We’ve tried to remain bi-partisan throughout the process. We’ve been slightly biased as we’re more “in the center” than the proposals submitted by either side. We’ve always supported a more organized system (probably through a light intervention of government simply due to the make-up of the existing system) and one focused more on organized delivery and efficiciency. We’ve recognized the unfair reality of the current system that leaves a significant portion of our population with limited or no access to care but always felt that issue can be addressed as the delivery system itself becomes more efficient. The heavy involvement of government and the focus on covering everyone out of the shoot (insurance reform) as the primary goal just doesn’t make sense.

The talking points were clear as we watched the debate unfold on Saturday. Democrats were demonizing the insurance industry and were doing all of this to protect the poor consumer and Republicans were appalled with the size of the legislative monstrosity that was sitting on the table in front of them. While we certainly understand being critical of the lack of consumer focus of our health care industry, as consumers, we leaned more toward the Republican side on this one.

If you don’t want to read all 2074 pages of HR 3590 you can get a pretty good idea of the content and implications by reading CBO’s scoring of it. You can get it by going to the Resource Library on our site, or by clicking here. CBO’s letter is another “caution flag” for us considering all of the qualifications they had to use to come up with the numbers. There was certainly some creative accounting involved and we think the numbers provided are all on the low side. Remember, Medicare blew out its budget within the first two years after it was enacted in the mid-60s.

We seriously question the ability to our country to finance such a massive piece of social legislation without further adding to our national debt (despite the numbers provided by the CBO). We seriously question the feasibility of setting up co-ops or public option alternatives to be competitive in an already fragmented market (these folks have obviously never been in negotiating sessions between health plans and providers). And, we question the ability of establishing a government-based infrastructure to address the real issues of prevention, wellness, care coordination, efficiency, and patient-centered care.

In a previous posting we recommended Obama and the legislative process slow down and do this right. We can only reiterate that here but don’t think it’s going to happen. You can read a letter sent to Obama from Newt Gingerich and a host of others that reflects our views by clicking here. Unfortunately, the Democrats are now more focused on a deadline of getting this done before the end of the year as opposed to doing it right. The Republican votes are already lined up no matter what takes place in the debate over the next few weeks. Once again, it’s going to be the Blue Dog Democrats who will determine the outcome.

Our economy is still on the precipice and our unemployment rate remains high. We have two wars that need to be appropriately funded to protect the men and women who are sacrificing their lives to protect our freedoms. These should be the priorities of focus and deserve the appropriate financial resources. We will reiterate- “government-light” not “government-run”.
We wish someone would call a “do over” on this one

Health Care Reform- Continues To Focus On The Wrong Issues

It’s looking more likely that we will have some type of health care reform legislation enacted in our country. It’s also looking more likely that the legislation that will be enacted- will not address the fundamental issues facing our health care system. Politics wins.

A new poll conducted by Stanford University with the Robert Wood Johnson Foundation found that 43 percent of Americans oppose the health care plans being discussed in Congress while 41 percent are in support. 15 percent remain neutral or undecided.

These numbers have remained relatively consistent over the past month but the opponents have stronger feelings on the issue than do supporters. Seniors justifiably remain more skeptical than the younger generations.

Americans are worried about the fine print included in the health care overhaul. With the House Bill (3962) weighing-in at 1990 pages, who can blame them. You would have thought that the House would have learned from the Clinton Reform effort of the 90’s that coming out with a monstrosity of legal jargon that the average citizen is not going to comprehend is going to lead to skepticism of its content. But, the Democrats have the numbers on their side (at least in theory) that could tip the discussion their way anyway. That’s what we’re afraid of.

Unfortunately, the reform discussions continue to focus on the wrong things. The primary focus continues to be centered on “providing health care for the uninsured", when the focus should be about reorganizing care delivery, improving communication and consumer awareness, coordinating care more effectively, improving system efficiency, and developing new payment methods to assure a quality health care system is available to all citizens.

One of the frightening facts of the recent poll finds that consumers are afraid of the increases in their current costs because “people in poor health who’d been shut out of the insurance pool would now be included, and they would get the medical care they could not access before”. These individuals need to realize somebody is already paying with the system we have today- and it’s more expensive than if all individuals had access earlier in the game rather than waiting for an emergency.

Instead of focusing on “insurance reform” (public option, mandates, etc.) we need to focus on changing the current trajectory of health care costs for individuals who already have health care coverage. There is more than enough waste in our current system to provide for those not “insured” by developing a more organized and collaborative structure than we have today. There is no reason why people in poor health in our country should be shut out from access to appropriate medical care. This is inexcusable. We need to address both.

We just believe the current reform models being discussed in Congress are going about it the wrong way.

What Is Our Definition of our Health Care System?

Carl Bialik posted an interesting article in the Wall Street Journal a few weeks ago. Grab it Here If You Want. The article, “Ill- Conceived Ranking Makes for Unhealthy Debate” discussed the flaws in the data used by the World Health Organization nearly a decade ago to come up with the infamous “37th in the world” ranking we’re all familiar with. I actually think he got his title backward, it should read “Ill-Conceived Ranking Makes for Healthy Debate.”

One of the primary objectives of the World Health Organization when they released the study was to “stimulate debate and focus on health systems” as opposed to just focus on individual components. The data and methodologies weren’t perfect, but it provided a benchmark. We all knew we could do better particularly when the cost is added to the formula. No matter what the final ranking actually may be we all know we can do better than we’re doing today. And, we’re talking about it so it achieved its original purpose.

But, that wasn’t the issue that caught my attention.

When explaining the decline in the country’s ranking in child mortality and life expectancy since 2000 the article stated, “But some researchers say that factors beyond the control of the health-care system are to blame, such as dietary habits.”

And, Alan Garber, an economist and professor of medicine at Stanford University closes the article by saying, “We might get more bang for the buck by setting aside some of our health-care money to support novel approaches to improve nutrition, education, exercise, or public safety.”

Until we all get on the same in our definitions the health care system will continue to struggle. In our view, nutrition, education, and exercise (and many others) are not “novel approaches”, but fundamental participants in the health care system that is evolving. And, dietary habits should be included in any research as they are critical in evaluating the whole-person and determining the approaches or strategies to improve the health of an individual.

We obviously define “health-care” different than others.

As long the majority continues to define health care as the “diagnosis-focused insurance financed” system we have today (as indicated in this article) instead of including health, wellness, and lifestyle as critical components; we might end up even lower than 37th- no matter what flaws may be in the data.

Independent Voters Will Make The Difference in Health Care Reform- And Everything Else

Independent voters (those independent of political affiliation of the two major parties) have always been a part of our political landscape. Both political parties target the “independents” during election cycles as the only way to assure victory because neither one can seem to acquire the numbers they need on their own.

From all of the talk in Washington, you would think health care reform is all about Republicans or Democrats- it’s not. It’s what the independents want that will make the real difference. For the first time in a long time, independent voters outnumber those affiliated with either major political party.

The Pew Research Center provides an interesting visual of the history of individual affiliation with our political parties over the past 70 years. You can link to it by clicking here.

Starting back with Franklin Roosevelt in 1939, independent voters made up 18% of the electorate. At that time, Democrats made up 41% while Republicans were at 35%.

As we all know, party affiliations change with the times. Democratic affiliation peaked at 51% in 1964 after the Kennedy assassination and Republicans dropped pretty substantially to 25%. Independent voters increased to 23%.

Since that time, the affiliations of both major political parties have continued to erode. With the exception of a brief spurt during the Reagan years, the Republican Party has had a tough time solidifying a base. Democrats have not had much more success.

Beginning in 1991, under Bush I, the Republicans, Democrats, and independents have all been competing as equals in addressing the needs of the American people. And, in 2009, independent voters now make up 36% of the electorate, Democrats have 35%, and Republicans 23%.

So as we continue on with all of the partisan politics that’s taking place in Washington regarding reforming our health care system, both parties better realize it’s not those that are affiliated with them that will be their staunchest advocates or most vocal critics. It will not be a Democratic or Republican agenda that will make a difference. It’s the independent voter that will have the biggest impact. Congress (both sides) had better listen.

And, from what we’re seeing, we can expect the independent ranks to grow even larger in the future. Because we don't think that they really are.

Consumers Value Health Care Different Than Health Care Values Health Care

I had the opportunity to speak at Life University’s homecoming over the weekend. Many thanks go out to the folks at Life, and particularly Dr. Stephen Bolles for making it a really enjoyable experience.

My topic was centered on “delivering value” in health care, not from a clinical standpoint or a health plan standpoint, but from a consumer perspective. We haven’t heard much about the consumer’s perspective of what they are searching for in the health care debate (except through the emotional interaction of the Town Hall meetings over the past few months). I'ts about time we started to listen.

I felt it was important for the audience at Life University (clinicians) understood the brutal realities of the health care market they are part of. We all know the numbers, we spend too much, our results aren’t what they need to be, and there is a very real possibility that the whole financial model could crash if we don’t do something about it. Consumers don’t trust the health plans, they don’t trust their employers, and they certainly don’t trust those in Washington making the decisions to “reform” the system we have today (I’ve written enough on my views on what’s going on with the whole reform fiasco). Due to the lack of trust, consumers get a lot of their information today via the internet. Eighty-eight percent of them validate the information they receive on the internet with their health care providers. Eighty-eight percent of those people then validate the validation they received from their health care provider with family and friends. Health care information is a social phenomenon.

The definition of “value” in health care from a consumer perspective (from the outside) has a very unique context around it. Value from a consumer’s perspective is something they can trust, is personally relevant to them, delivers the results they expect, and can help them navigate through the mess we have today when they need to navigate through the mess. Value is very personal when looking at it from the consumer’s eyes.

The definition of value for those inside health care is totally different. Value is based on outcomes and cost. Value is about following the right protocol or the right formula in delivering care. The value of health care is transactional- not personal. And, as we all know, our health care system has become a system based on a series of transactions- not relationships.

My argument has been that until we start to recognize and appreciate the definition of value from a consumer perspective, we’re never going to get them involved. They will continue to be merely participants aimlessly following the confusing rules and processes we have laid out for them. Yes, they might be “nudged” along by incentives (another transaction) to get them to do the right thing- but they are not going to engage and do the things we will need them to do to be truly engaged and active participants in their health and in the health care system itself until a relationship is established. We have a long ways to go.

Our health care system has become a fragmented array of individual self-interests focused very narrowly on individual points of view. To really reform our system will require a change in perspective for many of the individual self-interests to work in a more focused and integrated manner than they ever have before. And, while not discarding the health care system’s definition of value, they will need to focus much more on the definition of value from the perspective of those receiving care. Patients are not a transaction- they are a person.

Did anyone really hear my message at Life? I don’t know, but it felt good getting it out there for others to think about.

State Health System Performance- Confirming What We Already Know

The Commonwealth Fund just released its state scorecard on health system performance. We posted it on our site under the “Health Systems” section in our library at http://www.collaborationhealthcare.com/ or you can grab it by clicking here.

The study looked at a number of indicators to determine its rankings of the states. In 2009, Vermont, Hawaii, Iowa, Minnesota, and Maine/New Hampshire came out on the top and Florida, Louisiana, Nevada, Texas, Arkansas, Oklahoma, and Mississippi came out on the bottom.

The main message once again pointed to the significant variation between the states that continues to exist in access to care, quality, costs, and outcomes for individuals. Even those states at the top of the list had some room for improvement.

Perhaps most striking is the amount of dollars that could be saved in the system we have today simply by organizing care more effectively and dealing the costs associated with the unhealthy lifestyles of our population:

$5 billion for unnecessary re-admission to hospitals or nursing homes

$37 billion “outlier” Medicare costs

$193 billion for tobacco-related health care costs

$147 billion for obesity

So as we continue to move through the health care reform debate, we’ll continue to argue that the issue is not whether we have a public option, or co-ops, or whatever else we want to throw in there. The issue is not making the health plans, the doctors, or the hospitals the “bad guys”. The issue is how this system is organized and how care is delivered and paid-for in the system we have today. Until we deal with the fundamentals, the rest is simply irrelevant.

The Commonwealth Study only reinforced what we already know. I just hope we do something about it.

A Local Conversation for Integrative Health

We were pleased to take part in an event the other day hosted by Northwestern Health Sciences University and co-sponsored by the University of Minnesota's Center for Spirituality and Healing, School of Nursing, and LifeScience Alley. The theme; Integrative Health: Implications for Patients and Purchasers was designed to be a "local conversation about healthcare reform".

The event was well represented by many of the key health care stakeholders throughout the Twin Cities area and was indicative of the interest the market (or at least some key stakeholders) is beginning to show for integrative health care approaches and the role it can and should play in the new system that is evolving. The attendance was also indicative of the need for more of these types of discussions to share ideas, collaborate, and simply provide a venue to let everyone know what is going on in a changing world.

Mary Jo Kreitzer, PhD, RN (Director, Center of Spirituality and Healing) summarized the evolution of integrative health care from the beginning to where it is today. She pointed out that integrative health care has moved from "alternative" to a position to where it can and should play a much more integral role in health care delivery.

Charles Sawyer, DC (Sr. VP, Northwestern Health Sciences University) reviewed the escalating health care cost statistics we are all so familiar with today.

Patrick Geraghty (President and CEO of Blue Cross and Blue Shield of Minnesota) discussed the changing culture of his health plan from being a "health insurer" to a "health company" in response to the changing market expectations and demands.

Carolyn Pare (CEO of the Buyers Health Care Action Group) outlined the expectations of the employers in the new health care market and their interest in "value" not just new gimmicks or "stuff".

Frank Cerra, MD, (Dean of the Medical School at the University of Minnesota) discussed the changing roles of the providers, and emphasized that real health care reform needs to come from the providers and those delivering care.

When you reflect on the total context of these individual discussions it is very clear that the health care market is already changing. Relationships are changing and many of the delivery models that exist today won't be around a few years from now. Integrative health care with a "whole person focus" has a wonderful opportunity to play a much, much, larger role in health care delivery than it does today. We just need to develop the innovative approaches and the business models to make sure it happens.

The time is right.