As the nation moves closer to major healthcare reform, who better to speak about universal coverage than Massachusetts healthcare leaders?
The Bay State is the closest to universal coverage with its system based on an individual mandate that requires everyone have health insurance. At the Transforming Healthcare forum in Boston Thursday, a group of Massachusetts healthcare leaders explored the issues of healthcare reform, the $150 billion healthcare portion of the stimulus package, and President Barack Obama's budget proposal.
James Roosevelt, Jr., president and CEO of Tufts Health Plan and member of the Obama Presidential Transition Team, said federal policymakers can learn from Massachusetts' reform. "The beauty of what we accomplished in Massachusetts, in addition to providing healthcare coverage in a cost-effective manner, is the legislation shined a light of day on healthcare costs. It was never framed as a true public policy before," said Roosevelt.
In his healthcare proposals, Obama has linked healthcare reform to stimulating the economy. Without major reforms at the federal level, the numbers of uninsured Americans will swell to 54 million within a decade. Losing coverage and facing rising healthcare costs will force many into bankruptcy. Echoing comments made by Obama on Tuesday, Roosevelt, the grandson of President Franklin Roosevelt, said healthcare costs force an American to declare bankruptcy every 30 seconds. "That is wrong and it must change," he said.
The health plan executive said the nation must build its reform program on top of the current employer-based system and not create a new system, such as single-payer, from scratch. "I don't think we can copy any system from another country that started with a different system," he said.
Roosevelt said major healthcare reforms should focus on four areas:
- Ensuring quality and effectiveness
- Improving the primary care system
- Providing transparency for cost and quality
- Addressing racial and income disparities
"This is a tall order and I don't have all the answers . . . I will tell you that the winds of change have come to Washington. We do have an unprecedented opportunity. We are on the verge of a national program that is as historic as any legislation in our time," said Roosevelt.
Roosevelt, who predicted senators Ted Kennedy and Max Baucus will present a healthcare reform package in the fall, said the road to reform will not be easy. He suggested healthcare leaders, policymakers, and stakeholders should discuss costs, but the debate should not devolve into fear mongering and inflammatory statements, which he charged is already happening on the topic of comparative effectiveness.
Though Obama expects major healthcare reform within the year, Charlie Baker, president and CEO of Harvard Pilgrim Healthcare, suggested changes should be incremental. He warned that policymakers and industry leaders should not overpromise and under deliver.
"[Health care is] 18% of the [gross domestic product]. It's hard to turn it on a dime," said Baker.
Medicare
As part of his budget plan released that was released Thursday, Obama proposed paying doctors for quality rather than individual services. In order for Medicare to create a quality-based system that is supported by physicians, John Glaser, PhD, chief information officer at Partners Healthcare, a major integrated healthcare system in Boston, said CMS will have to provide "meaningful incentives," such as 10% to 20% increases for providing quality.
Baker said whoever becomes the next Health and Human Services secretary should fix Medicare first. He added Medicare drives the rest of the system and its payment system, which favors specialists over primary care physicians, is a reason why many doctors choose specialties over general practice. "If you don't change Medicare, it's hard to change anything else," said Baker.
Roosevelt, however, said Medicare problems alone are not enough to spark changes, but would need to be part of a larger healthcare reform plan.
Health IT
The stimulus package included $19 billion for healthcare information technology, but there are still plenty of questions surrounding the plan.
Healthcare leaders at Thursday's event questioned whether 100% of physician practices will have electronic health records (EHR) within five years, which is a goal in the stimulus package. Glaser said the feds should create more realistic goals that show progress in areas of e-prescribing and quality reporting. While the stimulus bill calls for doctors to have EHRs, Jonathan Bush, cofounder, president, and CEO of athenahealth, which offers electronic medical records and practice management solutions to physician practices, said industry leaders should not expect to save money from EHRs. In fact, EHRs have a negative return on investment.
Glaser, however, said health officials should not affix a bottom-line return on investment because EHRs help improve care, reduce errors, and improve access to patient records—and there is no price tag on patient safety.
Glaser said Partners has worked to improve EHR efficiency, but acknowledged that doctors still spend more time filling out a digital prescription than it takes writing a prescription. Because of the added time, physicians have resisted the technology, which Glaser said shows the importance of paying doctors extra for using EHRs.
Another issue with the stimulus plan's language is that it requires "meaningful use" of EHRs. Glaser said the question is: What is actually considered "meaningful use" for doctors? He hopes the feds answer that question by the fall.
Comparative effectiveness
Though it comprises a mere $1.1 billion of the $150 billion healthcare portion of the $787 billion stimulus package, comparative effectiveness, which compares different treatments, has received the most opposition of any of the healthcare-related parts of the package. Conservative radio hosts, most notably Rush Limbaugh, have criticized the notion as a step toward socialized medicine.
Baker said the country needs a national debate on the issue. ". . .This one really hits a raw nerve about decision making and ultimately about coverage and what gets paid for and all the rest. I think this is a conversation we desperately need to have," said Baker.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.