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Health Reform Benefits All Parties

Health Care Providers Will Also Benefit from Reform

A panel of experts joined CAP Action to discuss the implications health reform will have for health care professionals and consider successful models of innovative reform.

“[New and innovative health care] systems are no longer theoretical; they are functioning successfully today,” said Dr. Bob Berenson, a Urban Institute fellow, at a Center for American Progress Action Fund event on Tuesday. “We’ve let the genie out of the bottle so that health professionals themselves are going to demand improvement in delivery systems.” The event featured the report, “Health Reform: Delivering for Those Who Deliver Health Care,” which Berenson co-authored with Dr. Ellen-Marie Whelan, Associate Director of Health Policy and Senior Health Policy Analyst at CAP Action.

The report highlights the key areas of health reform that will help providers better serve their patients, such as insurance coverage expansion, delivery system reform and payment innovation, a focus on prevention and wellness, enhanced primary care and chronic care management, and comparative effectiveness. A group of panelists, including doctors, nurses, and a physician assistant, joined Berenson and Whelan, among them American Academy of Physician Assistants President Cynthia B. Lord; American Academy of Nursing Secretary Diana J. Mason; American Medical Association President Nancy Nielsen; Frederick E. Turton Chair-elect to the Board of Regents, 2008-2009, American College of Physicians; and Ronald A. Paulus, Executive Vice President and Chief Technology and Innovation Officer at Geisinger Health System.

“Geisinger Health Systems is at the forefront of successfully implementing innovative models of delivering care,” Whelan said. She introduced Paulus, the keynote speaker, who has been responsible for much of Geisinger’s system wide innovation. Geisinger has implemented a cutting-edge system of electronic records that provide health care professionals with instant, comprehensive patient histories. The system also allows patients electronic access to their procedures, appointments, and billing through customized web portals.

Geisinger takes a data-driven approach to examining benefits for both the patient and the healthcare providers. “We measure broad trends, and we measure at the patient level and give the patients a report card,” Paulus noted. “There’s no such thing as non-compliance, the patient is simply complying to another treatment plan.” Taking the extra time to make sure a patient understands his health conditions and what preventative measures he can take to improve wellness reduces the cost of care in the long run.

Health reform must tackle perverse financial incentives that pay for high tech procedures and high volume but do not always reward doing what is best for the patient. Berenson explained that, “Physicians are constantly having to make compromises and work around a patient’s limited or non-existent insurance coverage.” Improved financial incentives, along with expanding insurance coverage to those who are currently uninsured or underinsured, will make it easier for doctors, nurses, and other health professionals to uphold their professional ethics and provide the best care to those who need it.

Geisinger is seeking to eliminate perverse incentives by making health providers accountable to specific quality standards before they are eligible to share in any money they have saved the hospital. Geisinger has also used empirically driven models to improve quality and decrease the cost of care. Hospital re-admissions, for example, are often preventable and costly. Geisinger used data to identify patients who are at increased risk for readmission and then spent extra time to equip those patients with the knowledge and tools needed to avoid re-admission.

The current standard payment system severely reduces the amount and quality of time health professionals spend with patients, a problem that would be ameliorated under a reformed system that includes better primary and chronic care management and a focus on wellness and prevention. “We don’t do health care, we chase the disease,” Lord said. An approach that seeks to include the patient in their care through education and prevention methods will benefit patients and health care providers. Mason pointed to the 11th Street Family Health Center in Philadelphia as a model of this philosophy. This clinic takes a public health approach to wellness; for example, it created a community garden to compensate for the unavailability of fresh produce in their urban neighborhood.

Health care reform will not only improve care for patients, but it will also improve conditions for health care providers by creating an environment where patient care can be the first priority. As Nielsen, president of the AMA, said, “If we are going to get change we must be willing to lay down arms and we must have a leap of faith that we can do better in this country, by focusing on the needs of our patients we will design a system that allows us all to survive.”

For more information, please see the event page.