The Mayo Clinic Health Policy Center and Health Affairs hosted a national symposium Achieving the Vision: Advancing High-Value Health Care December 5-7, 2010. The first panel discussion focused on ensuring that patient-centered health care delivery thrives.
Moderator:
Tim Johnson, M.D., Chief Medical Editor, ABC News
Panelists:
James Rohack, M.D., Immediate Past President, American Medical Association
Darrell Kirch, M.D., President and CEO, Association of American Medical Colleges
Mary Grealy, President, Healthcare Leadership Council
Karen Ignagni, President and CEO, America’s Health Insurance Plans
DeAnn Friedholm, Campaign Director, Health Care Reform, Consumers Union
Moderator Tim Johnson, M.D., began the discussion by asking the panelists to identify the single highest priority that will relieve patient concerns about the U.S. health care system, and whether the Affordable Care Act (ACA) addresses these concerns in any way.
Dr. Kirch commented that patients are often concerned about insurance-related issues, but there are still many other deep problems in health care that need to be addressed, such as the need to reward value rather than volume in the payment system. This culture shift must be led by health systems and providers, and a population health focus must be achieved. In addition to providing care, high-value health care systems can train providers in care models of the future and lead the way in patient-centered health care reform.
Karen Ignagni built on Dr. Kirch’s comments by adding that it is important for everyone to participate in the health care system as insurance reforms are implemented. Patients are anxious about rising costs, which is a concern that can be partially addressed by shrinking variation and incenting best practices. She also emphasized that the private sector must be engaged and take a leadership role in identifying priorities and ways to bend the cost curve—considering the difficulties in encouraging Congress to take effective action.
Mary Grealy agreed and added that one of the most important aspects of the ACA is the creation of the Center for Medicare and Medicaid Innovation (CMMI) to serve as a laboratory for new ideas in improving health care delivery. She acknowledged that there is concern that the results from the CMMI won’t be diffused rapidly enough, given the fact that over 30 million newly insured Americans will be added to the system by 2014. It is vital for CMMI to build upon delivery reform successes that are already taking place in the private sector and to diffuse results quickly.
Dr. Rohack noted that that the Medicare program drives how medicine is practiced and that a permanent solution to the Sustainable Growth Rate (SGR) formula is needed. Certain elements in the ACA are designed to incent high-value health care through the Medicare program, but these may be difficult if physician payments are cut because of SGR. He also emphasized that physicians need to be comfortable aligning with one another, and safe harbors need to be considered from a Federal Trade Commission perspective.
Finally, DeAnn Friedholm discussed that health care costs remain a top concern to patients. She also emphasized that patients need the appropriate number and type of providers tensure appropriate access. The panelists all agreed that people need to be empowered to be good decision-makers in their own personal health care experiences, but most patients don’t consider themselves active participants in the health care system. There is a need to build a mandate for high-value health care, but patients don’t currently understand what high-value health care is or what to expect from an effective system. The panelists were also in broad agreement that patients must be educated about high-value health care by showing how increases in value can have personal impacts on their lives.
Overall, the panelists agreed that the Affordable Care Act has elements that can further patient-centered health care, but much more needs to be done, particularly in diffusing private sector successes and engaging patients as consumers to advocate for high-value health care
After the panel concluded, attendees worked in small groups on two questions, submitted responses, and prioritized the responses as a large group. The questions and the top five responses follow:
How can we rapidly improve the experience of patients and make them more effective partners in making choices about their health care utilization?
1) Provision of care management is needed, particularly for chronic illness and elderly patients, to assist with communication and longitudinal care completion across the spectrum of providers.
2) Implement patient centered shared decision making with incentives to patients for compliance and adherence to the plan.
3) Make health care more user-friendly through virtual access, timely visits, patient education, and other initiatives.
4) Work toward a government-mandated and subsidized health care record (second vote after brief discussion)
5) Utilize patient-centered medical homes or other team approaches to enhance patient education levels and empowerment supported through new payment mechanisms. Improved reimbursement is necessary.
What delivery system changes can we make in the next two years to make health care more affordable and less burdensome to families?
1) Change incentives — clinical, financial and cultural — to allow patients to move through an individualized continuum of care across all settings.
2) Fill in the gaps to improve the efficiency of care.
3) Incentivize providers to join organized systems of care.
4) Provision of protocols and care management to target advanced illness.
5) Support better coordination of care through removal of legal barriers, improved health IT, alignment of reimbursement and medical homes.
Below you will find video of two of the panelists discussing the future of high-value, patient-centered health care:
- Mary Grealy, President, HealthCare Leadership Council
- DeAnn Friedholm, Campaign Director, Health Care Reform, Consumers Union
- James Rohack, M.D., Immediate Past President, American Medical Association
