OBSERVATIONS - july 3, 2008
Mayo Reform Vision Focuses on Delivery System
The often heated debates over national health reform don’t get many laughs. So it was refreshing to read how Dr. Denis Cortese, the president/CEO of Mayo Clinic, explained why his organization (or at least its policy institute) has taken a high-profile role in promoting a vision of national health reform. It’s because, he told a Lacrosse, Wisc., reform symposia a few weeks ago, “Somebody has got to do something, and it’s just incredibly pathetic that it has to be us.”
Loyal Deadheads will of course recognize those words as coming from the late, great Jerry Garcia, who wasn’t talking about health reform.
Humor aside, what’s encouraging (and not at all pathetic) about Mayo’s ongoing series of national and local reform symposia is the emphasis it is bringing to delivery system reform, as opposed to the narrower, more common focus on universal coverage.
Fortunately, Mayo has not been alone in promoting this broader, more balanced vision of health reform. Kaiser Permanente’s Institute for Health Policy has been long been promoting the idea that “delivery systems matter” -- the notion that sustainable reform begins (but does not end) with more systematic, evidence-based, coordinated, patient-centered care delivery. In addition, Kaiser Permanente’s CEO, George Halvorson, has been preaching from much the same book (in fact, he’s been writing the books (see Health Reform Now!), as has George Isham at HealthPartners in Minnesota and a handful of other physician leaders at large, integrated delivery systems. MedPAC commissionsers Jay Crosson, MD, (also of Kaiser Permanente) and Nick Wolter, MD, from the Billings Clinic, have also been promoting delivery system reform measures through what they term Accountable Care Organizations, and on Multispecialty Group Practice.
While all of these organizations and individuals embrace the goal of universal coverage, they approach the issue from the perspective of the delivery system rather than viewing the challenge as merely one of financing and access reform. They recognize, better than most, that the delivery system is the key driver of health costs, which constitute the key driver of the growing legion of uninsured Americans. Note that only one of the four “cornerstone” principles of Mayo’s vision of reform -- individual ownership of mandatory health insurance (with subsidies for the low-income) -- addresses coverage and financing. The remainder deal with broad approaches to improving the quality and efficiency of how health care is organized and delivered. They include: provider payment reform (aligned financial incentives to doctors and hospitals for quality outcomes, prevention, and wellness), universal clinical IT implementation (wiring the delivery system for evidence-based medicine), and ways to promote value purchasing (rewarding plans for quality, transparency, care coordination, and efficiency).
This is an approach to reform built on the real-world knowledge that solving the coverage problem of the uninsured (by whatever financing scheme) is not enough – not near enough. In fact, absent reform of this country’s fragmented, irrational health care delivery non-system, universal coverage might well prove a self-defeating disaster. After all, it’s the siloed, system-defying way that health care is delivered in most of America that is largely responsible not just for this country’s mediocre quality of care, but also for the unsustainable rise in the cost of care. Reforming the insurance and financing arrangements to bring the uninsured into a dysfunctional health care non-system could prove to be a phyrric victory of historic proportions.
What would really be pathetic would be a health care reform debate that fails to hear from and learn from the perspectives of actual health care delivery systems that can legitimately be called “systems.” These are the voices that will need to speak out with greater clarity and persuasion if America’s dream of comprehensive, rational, sustainable, affordable health reform is ever to be realized.
- Jon Stewart, Communications Director,
KP IHP
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