May the discussion and the debate serve this country well …

“From a pharmacist’s perspective, health care reform needs to involve the use of the pharmacist as primary health care providers. Pharmacists are the most accessible health care provider and yet the most underutilized. Due to this accessibility, pharmacists can be involved with patients’ health care decisions in at least two very direct ways. The first is the correct use of their medications. A pharmacist must employ their knowledge to educate patients on the benefits of using their medications correctly and the dangers of using them incorrectly. When used properly, the benefit of medications far outweigh the cost, especially when compared to other comparable treatment choices. There are studies that have demonstrated that billions of dollars are spent on health care every year to treat the problems that are caused by incorrect use of medications. The second way is to help patients make behavioral changes in their lives which affect their health. Two examples would be weight control and tobacco use cessation. A pharmacist can recommend strategies, including medication therapies, to assist patients in making these behavioral changes in their lives to help prevent diseases. A pharmacist needs to be directly involved with the decisions about medication therapy so that patients receive the appropriate medication and are educated on their correct use. Pharmacy education today trains the pharmacist to be involved with these activities and to use their knowledge to provide optimal health care to the patient. This will involve some cost, and a pharmacist must be compensated for their cognitive services. This may include paying the pharmacist for not filling a prescription if it would not benefit or may even harm the patient.” 

Cost disclosures

Richard Blomquist, President
Blomquist Benefits LLC
Brookfield

“If you want to understand why anything happens in health care, simply follow the dollars. There are four changes that can be made to the existing system that will reduce costs, significantly limit cost increases, improve quality, improve access, streamline administration and expand insurance coverage.

Price transparency: Today we do not know the true cost of even the most routine procedure. Each hospital should be required to disclose the average private sector revenue for the top 20 procedures.

Change the PPO and HMO contracts: Both hospitals and physicians should be reimbursed according to a fee schedule.

Change benefit plan designs: The designers of benefit plans should create plans that embrace the schedules.

Create global services: Under these services, all of the parts of a procedure are contained in a single contracted price.

These changes can be implemented by the end of this year with no government intervention or expense. On the flip side, the current proposal of a government-sponsored ‘public plan’ will increase Medicare taxes by 20 to 30 percent within two years. We have the ability to control health care costs in a fashion that benefits patients, providers and payers.”

Value-based incentives

Steve Brenton, President
Wisconsin Hospital Association
Madison

“A disturbing trend has emerged over the past couple of weeks in Washington, D.C. The health reform discussion has morphed into a debate about how much to cut hospital and physician payments so that ‘savings’ can be spent to expand coverage for the uninsured. In addition to large Medicare cuts, the other area of focus has been on the ‘public (government) plan alternative,’ whether or not there will be a Medicare-like program that will ‘compete’ with commercial insurance. But the missing issue is … Reform. The importance of aligning payment and delivery is an essential element of transformational reform. Those statements of principle are supposed to serve as a roadmap to achieving lower costs and improved outcomes. So, it’s problematic that specific initiatives that actually incent this alignment are missing in action at this late stage of the debate. Health reform must align payment with high-level performance and quality. President Obama called for such an outcome during his recent visit to our state. That’s why WHA has joined with a handful of other state hospital associations to support a value-based incentive approach. The concept of real reform shouldn’t be MIA.”

Mandatory insurance

Jane Cooper, President and chief executive officer
Patient Care
Milwaukee

“Effective July 1, 2010, I would require that individuals/families who make more than 150 percent of the federal poverty level purchase insurance through a private plan or pay a penalty of $1,000 per year. Those who make less than 150 percent of the poverty level would also be required to purchase insurance but would receive a subsidy. The second thing I would do is revise Medicare reimbursement to physicians from fee-for-service to capitation.”

Transparency

Peter Frittitta, Vice president, benefits practice
R&R Insurance Services Inc.
Waukesha

“If I were in charge of health care reform, the most important thing I would do would be to mandate transparency of provider costs and provider quality. Price is what you pay; quality is what you get. The relationship between those two things determines the ‘value’ that you receive. Transparency would allow consumers to make more informed ‘value decisions’ about their health care purchases as they do with everything else. This puts competitive pressure at the consumer level – where it belongs since more costs have shifted their way. Today, more and more consumers are in a health plan design that has significant deductible and other out-of-pocket costs, so they now have more of their own money at stake. That certainly makes them more receptive to trying to make a more informed price/quality ‘value’ decision, as they didn’t need to in the ‘carte blanche’ days of low member cost plan designs. For example, people need to know that an MRI diagnostic service has a price range of $600 to $2,800 in southeastern Wisconsin. Bringing about grassroots competition among the providers (i.e., lowering medical costs) is key to lowering insurance costs. Consumer-driven competition will force health care providers to deliver the greatest value. Adding empty hospital beds in the marketplace does not provide value; it adds overhead price. Health care providers need to provide value by running more efficient, high-quality operations just as any non-medical business is challenged to do today to win and keep customers.”

Universal care

Don Hamm, President and chief executive officer
Assurant Health
Milwaukee

“Assurant Health strongly believes it’s critical that we as a country stop talking about health care reform and begin taking action. Any reform effort must be a shared responsibility between physicians, consumers, health insurers and policymakers - who work collectively to provide coverage for all Americans. We passionately believe that everyone must have access to high-quality, affordable health care, regardless of their income or health status. An important part of increased access comes from creating affordable options so that consumers can find a health plan that best meets their needs and those of their families. It is also essential that any reform measures take into account the information needs of consumers. Legislation must acknowledge the vital role that health insurance agents play as educators and trusted advisors. Providing consumers with less information and decreased decision-making support in an effort to save costs is not the answer. Americans deserve a better health care system, and that is why Assurant Health continues to participate in efforts to improve health care in the United States.”

Portability

Sue Hansen, Co-owner and attorney
Hansen & Hildebrand S.C.
Milwaukee

“I would first assure reasonable rates and availability for all individuals/families, with government plans or subsidies for those who cannot qualify due to pre-existing conditions or who cannot afford coverage. Such policies would need to be non-cancellable to avoid the current problem of individuals being dropped after developing health issues. This would take the pressure off small businesses and facilitate freedom of choice. I look through the lens of a small-business owner as well as a divorce lawyer who works with many families in transition. I see the impact of health care issues on me, others in my firm and my clients. As a small-business owner (who also needed individual insurance), I explored group insurance for our business, and the costs were prohibitive. As a lawyer, I see many clients in economic struggles and even bankruptcy as a result of uninsured medical costs and/or the unavailability of adequate insurance. Individually available comprehensive plans would also help avoid the excessively high COBRA costs I see when families experience divorce or loss or change of employment.”

Accountability

Dianne Kiehl, Executive director
Business Healthcare Group
Milwaukee

“If I was in charge of health care reform, the most important thing I would do is explicitly define what each health care stakeholder is accountable for and align financial incentives to support that accountability. Promoting accountability among all stakeholders is the most effective way to seek optimum health care value. Although the issue of health care reform is complex with multiple issues to tackle, I believe accountability should be a primary focus of meaningful health care reform. What would this mean for these primary stakeholders? Employers would be accountable for maintaining a healthy work environment, offering plans that emphasize primary care and supporting payment reform. They would provide benefit designs that remove barriers for seeking preventive care and motivate consumers to make decisions based on value. Consumers would be accountable for their lifestyles, compliance with preventive guidelines and treatment plans and the use of resources to make informed decisions based on value. Administrators would be accountable for timely and accurate claims processing and easing the administrative burden on providers and consumers. They would provide data analytics and tools that assist employers, providers and consumers. Providers would be accountable for the total cost of care, compliance with evidence-based guidelines, care coordination and outcomes, thereby offering truly patient centered care. They would be required to provide pricing and quality information in a standard manner so consumers can make value-based decisions. In addition, costly infrastructure and services should be considered based on community need.”

Mandatory annual exams

Dr. Victoria Mondloch, Independent obstetrician/gynecologist
Brookfield

“The most important thing I would do is emphasize the importance of a true wellness and preventive annual exam. An annual exam that includes a head to toe physical exam with height, weight and blood pressure are the basics that build a health care trend. Couple that with some basic bloodwork such as cholesterol, fasting blood sugar, thyroid and a blood count and the highest morbidity diagnoses are screened for: hypertension, stroke, diabetes and obesity. Results of bloodwork and vital signs then allows for a true discussion of dietary lifestyle and exercise habits; empowering the patient by showing them their basic personal health statistics, their basic state of wellness and giving them options to address their issues such as educational seminars and options for how to structure an exercise program that fits their time and lifestyle. Most patients want to spend approximately one hour of quality time with their health care provider. If that hour could be split into a half-hour physical and a half-hour to review their screening labs and vital statistics with specific referrals for dietary seminars and an exercise plan, now that patient is empowered by their health care provider to maximize their chances to positively impact their health. As health care providers, we have always recommended lifestyle issues such as diet and exercise to our patients. However, to truly set our patients up for success, most patients will respond and follow through if they are given specific recommendations that they do not have to research and find on their own. Thus, an hour a year can have a true impact on a patient’s wellness and the objective of prevention is not only met but the patient is empowered and educated in their own health and wellness.”

Eliminate all deductibles and co-pays

Jon Rauser, President
Rauser Agency Inc.
Milwaukee

“We should stop talking about who pays for health care, government insurers, co-ops etc, and focus on how we pay and what we pay for (outcomes!). Few can argue that health plan design directly impacts utilization. Plans with low co-pays or broad first dollar coverage see greater utilization than those with cost sharing. Such plans are unaffordable, especially in today’s economy. Conversely, the ‘qualified’ high-deductible health plans being sold today are criticized as simply a cost shift to employees. Here’s a compromise. Simply eliminate all deductibles and co-pays! Period. Replace them with 80/20 percent co-insurance; and the co-insurance out of pocket limits would be pegged to income. Example: a family with household income of only $35,000 would see their OOP capped at 20 percent of income or $7,000. This co-incidentally is about the same OOP limit as a typical $3,500 HDHP, but it cash flows differently for the lower income individual while preserving the ‘skin in the game’ that we know changes utilization. Premiums for such a plan would still be 25 to 35 percent less than a plan with a $250 deductible and co-pays. Additional incentives would reduce the 20 percent exposure. For example, if the insured completed a health risk assessment and any wellness coaching, the co-insurance might be lowered to 10 percent. When it comes to plan design, any reform should allow for choices; one size does not fit all. Legislation is needed so that plans without high deductibles are HSA-qualified.”

Health care is a right

Dr. Julie Schuller, Vice president of clinical affairs
Sixteenth Street Community  Health Center
Milwaukee

“Sixteenth Street Community Health Center is an independent, nonprofit agency that provides medical care, health education and social services at three locations in Milwaukee, employing nearly 300 people.  We are proud to be the medical home for more than 27,000 predominantly low-income Milwaukee residents, but like any small business, we are challenged every year to find the money in our budget to continue to provide health insurance for our own employees. If I were in charge of health care reform, the most important thing I would do would be to recognize that health care is a basic right for everyone, and work to make sure that care was not only affordable and available, but provided with sensitivity to language and cultural issues that can sometimes prevent people from getting the care they need.”

Value-based reforms

Dr. Nick Turkal, President and chief executive officer
Aurora Health Care
Milwaukee

“Real reform must be based on value. Much of the health care reform debate has focused on coverage – how to extend coverage to all and how to pay for it. Universal coverage certainly must be the goal, and yet extending coverage to all Americans would not in itself represent comprehensive health care reform. Real reform of health care lies in the quest for value. Value in health care can be defined simply as the health outcome you achieve relative to the amount of money you spent to achieve it. We enhance value when we improve the quality of care while also making sure that care delivery is as cost-efficient as possible. True health care reform means moving toward a system that measures outcomes and aligns incentives to encourage quality instead of quantity. Are we doing well by our patients? Are we keeping them healthy and out of the hospital? Are they benefiting from the latest medical knowledge? Are we coordinating their care across different services and throughout their lifetimes? Are we aggressively managing chronic disease? Are we providing appropriate care at the end of life? These are the questions we must be asking. Wisconsin’s health care providers have made good progress on cost efficiency and quality and now are well-positioned to succeed under a structure that rewards value in health care.” 

Independent commission

Bob Welke, Owner and chief executive officer
Welke Group
Milwaukee

“The most important thing I would do is to name an independent commission to come forward with an objective plan for fundamentally reorganizing health care in this country. Clearly, that commission would have to be carefully selected to balance health care experts, elected officials and consumers with a chairperson who engenders trust. I would advocate this step for no other reason than to clear up the waves of misinformation that are coming from all sides. People want change, that’s obvious. But we are at a loss as to a new direction in the face of political grandstanding and industry stonewalling. The voices we hear come from those who are only concerned with getting re-elected or maintaining the status quo. I’d tell them all to wait in the lobby while we get at the answers. Basically, this is what finally happened with the American auto industry, only it was called ‘bankruptcy court.’ That’s the choice we face.”