Change is inevitable, with or without ‘Obamacare’

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Print this page by Robert Powell

Forget what the Supreme Court thinks about “Obamacare.” Changes already are taking place in the private sector promise to alter the landscape of health care.

That was the message of a recent Richmond health-care conference sponsored by the Virginia Chamber of Commerce. Change is coming, speakers said, because spending more on health care than any other country in the world has not resulted in a healthier U.S. population.

There needs to be switch “from paying for volume to paying for value,” said John Syer, vice president of provider contracting at Anthem Blue Cross and Blue Shield.

The health-care conference was held in early June, a few weeks before the U.S. Supreme Court was expected to rule on the constitutionality of the federal health-care law. Dr. Bill Hazel, Virginia’s secretary of Health and Human Resources, acknowledged that many people want to know what the state would do when the Supreme Court reached a decision. That is the wrong question, he said. “What are we going to do with an unhealthy, aging work force? Virginia in 2020 is supposed to look like Florida does today…. How are we going to take care of all these people? Those are the real questions.”

Health-care spending now totals $2.6 trillion a year and accounts for 18 percent of the nation’s gross domestic product. Next on the world’s list of big spenders is Switzerland, where health care makes up only 11.5 percent of GDP despite government-paid coverage. “We have a problem, and we have to solve it,” Hazel said.

Part of the solution, many speakers believe, is adoption of a concept called the Patient-Centered Medical Home (PCMH). Patients often confront a fragmented health system in which they are treated by a variety of specialists. Under the PCMH concept, teams of nurses and doctors coordinate patients’ care and track their progress.

Dr. Paul Grundy, president of the Patient-Centered Primary Care Collaborative, said PCMH, which is slowly gaining traction in Virginia, has produced dramatic results in other parts of the country,  reducing costs for treating patients by as much as a third. Much of North Dakota’s health-care system now has converted to the PCMH model.  “As complicated as all this seems, it ain’t all that complicated,” Grundy said.

The three trends driving change to new health-care models, he said, are the industry’s current “unsustainable” cost, the ability to use data in treating patients and measuring performance, and new technology enabling patients and physicians to interact, often without an office visit.

But for change to take place, he said:

  • employers need to redesign their employee benefits, providing incentives for healthier behavior while encouraging checkups and screenings.
  • the health-care payment system has to be changed from fee for service to fee for outcomes.
  • physicians’ practices must be transformed and given the tools to coordinate patient care.

Dr. Sam Nussbaum, the chief medical officer of Anthem Blue Cross and Blue Shield/Wellpoint, said new health-care models are reducing emergency room visits and unnecessary services. “We have got to stop ineffective care,” he said, adding that about 30 percent of services that patients now receive are of little use, including PSA (prostate-specific antigen) tests for prostate cancer.

The cost and inefficiency of health-care system also is becoming an economic development issue. Rob McClintock, director of research for the Virginia Economic Development Partnership, said a growing number of business prospects are asking about health-care quality and accessibility because of their effect on worker productivity and quality of life. “Wellness, sports and outdoor recreation are moving to the top of the list” in sizing up a community, he said, noting that the outdoor image promoted by the Roanoke/New River Valley region helped it snag the East Coast distribution center for online outfitter Backcountry.com.

Health care also is a huge issue for existing Virginia companies. Bob Cramer, manager of human resources services for Norfolk Southern Corp., heads a Virginia Chamber health-care committee that provides a collective voice for employers, promoting best practices and promising initiatives. His Norfolk-based Fortune 500 company pays $400 million a year in health-care costs. “We can’t do this anymore,” he said, speaking on behalf of frustrated employers.

Some of the health initiatives that Cramer’s committee examines likely will come from the newly established Virginia Center for Health Innovation. Its president, Beth Bortz, plans to create a “one-stop shop” offering health-care stakeholders a chance to see what works in Virginia and elsewhere. The center also will establish metrics to gauge “What will success look like?”

No matter what fate the federal health care law faces, “it’s not going to change this kind of innovation,” said Dr. Thomas Auer, CEO of Bon Secours Virginia Medical Group. “The horse is out of the barn.” 


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