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Health Care Talk in Washington and Closer to Home

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(Guest blogger Daniel F. Evans is president and CEO of Clarian Health. He shared insights on incentives last week and will soon be offering an additional posting.)

I’d like to use this blog entry to comment on two events related to health care reform that took place Wednesday, though they differed dramatically in scale and attention received.  First, President Obama spoke to a joint session of Congress and the American people about health care.  As is usually the case, the president’s oratory was powerful and compelling.  He presented a strong case for reform. 

But his speech was disappointingly short on specifics on the question that I believe matters most – namely, how we change the incentives in our health care delivery system to support higher quality, more efficient and coordinated patient care delivered by trained medical professionals. The speech provided a lot of detail regarding how to expand insurance coverage to those who don’t have it and to protect those who currently have insurance from losing it when they need it most.  But it was very vague about how to pay for these reforms, and it was largely silent on changing the model of how health care is provided.  Nor did it contain any reference to the responsibility we all must take on for our own health and health care choices. In that sense, I believe it was a lost opportunity to advance a critical element of real and lasting health care reform.

Earlier in the day, the Indiana Health Industry Forum sponsored a thoughtful and expansive discussion of health care reform here in Indianapolis. Participants had the chance to hear from a number of experts on key elements of the various reform proposals under consideration in Washington. The panelists were informative and interesting, and reminded us of just how complex and challenging reform is going to be. 

Can we have lower costs but still support medical innovation? Do we have enough health care workers to provide care for the patients who will enter the health care system as insurance coverage is expanded? Can a system really designed to treat episodes of acute care adjust to provide a continuum of care for the chronically ill? 

All are fascinating and important questions without easy answers. Panelists also reminded us that reform will be an ongoing issue and will not be “finished” even if major legislation passes this year. To give just one example, the Medicare program has unfunded liabilities of more than $30 trillion. This is obviously not sustainable, so additional changes to the program will be necessary over time to keep it from swallowing our entire economy. Health care “reform” will be with us for many years to come, as our society continues to grapple with the challenge of paying for the care we want and need.

Makeover Needed for Health Care Incentives

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(Guest blogger Daniel F. Evans is president and CEO of Clarian Health. He will also be sharing additional health care reform insights in two additional postings.)

At Clarian Health, Indiana’s largest health care system and academic medical center, we have a big stake in seeing that the right kind of health care reform emerges from Congress in the months ahead. 

The right kind of health care reform starts by realigning financial incentives for hospitals and physicians to reward quality of care rather than quantity.  As its name suggests, fee-for-service medicine pays providers based on the volume of services provided, rather than on patient outcomes or quality metrics. 

Real reform will organize care around patients, not providers. Too often, patients see multiple specialists without sufficient coordination or communication, putting them at risk of receiving care that is redundant or even harmful. 

Real reform will expand access to care for the uninsured in a way that does not explode the federal deficit and exacerbate the inefficiencies and cost shifting of today’s system. Every day, we see the consequences of a system that does not provide regular access to health care services for millions of people.

Finally, real reform also will include incentives for individuals to assume greater responsibility for their health and their health care decisions. When the bulk of health care services are paid by third parties, either private insurers or public health programs, is it surprising that demand increases and costs soar? We must make more informed decisions about treatment options and provide incentives to people to maintain their own health.

Getting the “incentives” right is critical to improving our health care system.  If we want better quality and more efficient health care, we must reward doctors and hospitals that provide it.  If we simply cut payments to providers to reduce health care costs, the results will be terribly damaging to the well-being of patients and communities.