1. Keith Wisdom talked about how the individual mandate, by bringing everyone under the umbrella of coverage, could zero out the costs of uncompensated care for providers. | 2. We need to reform the way health-care providers are being compensated, said Bruce Bagley. | 3. Regardless of where health-care reform ends up, said Jill Watson, this is a rare opportunity to align the interests of providers, insurers and patients. | 4. Ed Fensholt said Americans must reconcile their behavior with a collective desire for the best treatments, regardless of cost.

 

 

 

 

 

 

 

 

The second way to reduce cost is through new utilization strategies involving the continuity and efficiency of care. Wisdom observed that there were many demonstration projects in process. “And when you find success stories,” he added, “you have to replicate them quickly, because the costs are coming quick.”

Ed Fensholt cited a recent test project in which four of 10 companies with integrated health-care systems had succeeded in controlling costs over a five-year period. The ones that did, said Fensholt, were the ones that found alternative ways to see patients and treat patients, including telemedicine and telephone consultation.

When asked if medical malpractice liability reform was part of the solution, Bagley demurred: “I think it’s a small factor, to be honest with you. It’s talked about a lot more than it deserves.”

David Gentile asked rhetorically whether all participants had to figure out a way to get away from the existing discounted fee for service towards an ACO type of model.

For the record, ACO stands for “Accountable-care organization.” More talked about than observed in the wild, an ACO is a network of doctors and hospitals with a shared responsibility for providing care to patients. Under the impending reform, an ACO would agree to manage all of the health-care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.

“Just transferring risk to ACOs isn’t the solution,” said Keith Wisdom. What is needed, he insisted, is a fundamental change in care management populations, in continuity of care, in physicians managing utilization.

“It’s a tough transition,” said Rick Kahle, “because the ACOs are only going to work if a critical mass is reached.”

Ed Fensholt spoke to the need for a fundamental cultural change to get costs under control. “One of the things we’ve gotten away from is accountability and a personal basis for our freedom of choice,” he observed.

“Americans have come to the point where we think we’re entitled to make our own decisions, but when we get sick we’re entitled to get all the care we want, immediately, and the best care available—‘and I don’t care who pays for it!’ We have to get away from that, from a cultural standpoint.”

And changing the culture is merely one of the challenges facing our beleaguered health-care system.

 

Return to Ingram's June 2011