Symposium Today

Friday, July 30, 2010

Welcome to Symposium Today, a daily summary of news, quotes, insights and media coverage from the Colorado Health Symposium.

In this issue:
Dartmouth Atlas founder: Reform glass is “half full”
Speakers focus on payment reform
News coverage and social media
Next up
Speaker slides available online

Quotes of the day:
“The data makes clear more capacity doesn’t mean more access.”

— Dr. Elliott Fisher
Director of Population and Policy,
The Dartmouth Institute

“The most important thing [about federal health care reform] is the signal it sends. And the signal it sends is that business as usual is over. We can’t afford it. The Chinese want their money back.”

— Dr. Len Nichols
Director of the Center for Health Policy Research and Ethics,
George Mason University

Keynote highlights: Reform glass ‘half full’ says Dartmouth Atlas founder
While the Patient Protection and Affordable Care Act won’t cure all the many problems facing the health care sector, there are many areas where the new health care reform law gets it right, said Elliott Fisher, director of population and policy of The Dartmouth Institute. Fisher delivered the keynote address on the final day of the Colorado Health Symposium.

“I want to tell the story about why the glass is half full in health care reform.” Fisher is credited as the man behind The Dartmouth Atlas, an online database that’s widely regarded as the gold standard on how medical resources are used and distributed across the United States.

The Dartmouth Atlas shows that regions spending the most on health care don’t enjoy better health outcomes than low-spending regions – debunking the common wisdom that “more is better” in the world of health care. It also shows that patient satisfaction and results are better in communities that focus on coordinated and primary care. Fisher cited Grand Junction as a prime example.

“The health reform legislation we passed really creates a window of opportunity,” Fisher said. “Reform should accelerate new performance measures and new delivery models – such as accountable care organizations and incentives for providers to work together to improve care and reduce costs.”

Fisher hailed the trend of patient-centered medical homes as “tremendously promising.” The medical home concept coordinates primary and specialty care between patients and their personal health care teams. Fisher pointed out that Colorado is already ahead of the curve in shaping the future of health care in the United States, citing the state’s Western Slope and safety net clinics as examples.

But he cautioned there’s still much work to be done. “Health care reform is at a very fragile moment,” Fisher said. “New payment models are vulnerable to rising costs, which could reverse coverage gains. You guys are already stepping forward.” In moving forward, he asked health care leaders to be bold and creative in trying new ideas, work to reduce empty rooms in hospitals that are driving up costs and even establish a “cash for clunkers” program that will let providers sell unnecessary expensive medical equipment.

Today’s discussion: Focus on payment reform
Federal health care reform and its consequences were among the topics of conversation among speakers at Friday’s Colorado Health Symposium. The discussion revealed both hope and concerns about the Patient Protection and Affordable Care Act. But the speakers agreed on one key point: Payment reform alone won’t fix what ails the health care system.

Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University, said while the 2,000-page federal health care reform law isn’t perfect, it is a catalyst for much-needed change. “The most important thing is the signal it sends,” he said. “Business as usual is over. We can’t afford it. The Chinese want their money back.” Nichols, a Symposium favorite who described himself as “a simple country economist,” said while federal reform won’t be “smooth sailing,” it forces the industry to re-evaluate incentive structures that aren’t sustainable. Despite the uncertainty and apprehension about federal health care reform, Nichols said he’s optimistic. “I’ve never seen such openness to change,” he said. While many of the speakers throughout the Symposium emphasized that patients need to be at the center of health care reform, Nichols pointed out that for reform to really work, the entire community including physicians, needs to be engaged and involved in the transformation.

Simon Stevens, executive vice president of the UnitedHealth Group, said while he strongly believes the payment system for health care is flawed, the much-maligned fee-for-service model isn’t the only culprit. “Many other countries use the same model and spend less [on health care],” noted Stevens, who served as health policy director for British Prime Minister Tony Blair. As the lone representative for the insurance industry among Friday’s speakers, Stevens expressed skepticism about tenants of the reform law, questioning whether there will be enough primary care physicians to serve patients and whether efforts to coordinate care will lead to improved care and controlled costs.

Steven Summer, president and CEO of the Colorado Hospital Association, summed up the new health care reform law as a mixed bag. “The law is not perfect,” he said. “It will have lots of unintended consequences. We will have to change it going forward, but at least we have something in place.” He said hospital administrators fear the reform act could launch “managed care 1.0, not managed care 3.0.” Summers said improvements to the system can be made when health care professionals work collaboratively in sharing data and insights on best practices and safety to avoid costly medical errors.

Mark Laitos, president of the Colorado Medical Society, reflected the apprehension that doctors are feeling about federal health care reform – particularly portions that pertain to incentives and reimbursement for physicians. Laitos, a family physician from Longmont, cautioned that incentives aren’t the only answer to improving health care. “This is not about squeezing every penny we want out of the system -- we do want to make our patients better.” He acknowledged doctors are skeptical about pay-for-performance arrangements. Naming Grand Junction as an example, Laitos said that real health care reform can only happen if communities are fully on board. He added the reform bill does nothing to limit the threat of large malpractice suits that force doctors to practice “defensive medicine” which drives up costs and skews clinical judgment. “This isn’t just a financial issue,” he said of defensive medicine. “[Doctors are] concerned they’re going to be pulled into court. It’s a terrifying primal fear from the doctor. Please don’t try to discount it.”

Andrew Webber, president and CEO of the National Business Coalition on Health, brought the perspective of more than 7,000 employers to the discussion. Unlike other speakers who extolled non-financial benefits of reform, Webber said the bottom line is key. “If it isn’t about controlling costs, then we haven’t done the job,” he said. Like other speakers, Webber said consumers need to be at the center of revamping the payment system. “We have let a toxic payment system be created, and we’ve got to take responsibility for it” Webber said. “We actually pay for medical errors and do-overs; we wouldn’t do that in any other part of the economy. Employers need to assume a role and take ownership of the consumer entitlement mentality. Combined with our fee-for-service mentality, you have the perfect storm.

News coverage and social media
The Denver Post on Friday highlighted remarks from Thursday’s Symposium. The article, from Post reporter Jennifer Brown, focuses on new approaches to health care delivery, including medical homes, online services and a bigger role for nurses.

Don’t miss Colorado State of Mind Friday night, 7:30 p.m. on Rocky Mountain PBS. The show, taped Wednesday at the Colorado Health Symposium, features Dr. Mark Wallace, president of Northern Colorado Health Alliance and executive director of the Weld County Department of Public Health & Environment; Dr. Jay Want, president and CEO, Physician Health Partners; Dr. Michael Soman, president and chief medical executive, Group Health Permanente; Gretchen Hammer, executive director, Colorado Commission for the Medically Underserved. The topic is “What Will Health Care Reform Look Like?”

 Follow Us on Twitter @HealthSymposium
You can review highlights from the Symposium by reading tweets posted throughout the event. We used the #10CHS hashtag for this year's Symposium posts. You can tag your own Symposium-related tweets with the #10CHS hashtag to join in the conversation. Search on #10CHS using Twitter Search to track all Symposium-related tweets.

 Visit the Colorado Health Symposium Blog
We featured summaries of the Symposium’s plenary speakers on blogs posted throughout the event. Add your two cents to the discussion by commenting on the postings.

 Connect with us on Facebook
Revisit the Symposium by "liking" our official Facebook page. We encourage you to share, comment on and "like" the Foundation’s Facebook posts.

 View Speaker Interviews on YouTube
Get behind-the-scenes with the Symposium on YouTube by viewing selected speaker video clips during the event.

Next up: The 2011 Colorado Health Symposium: July 27-29, 2011

Speaker slides available online
Looking for great statistics or tidbits from this year’s Colorado Health Symposium? Many speakers’ PowerPoint presentations are posted online. [learn more]