Mayo Symposium to Address
Health Care Reform
by Herb Drill
What ails the
medical system which most Americans, especially those of us who are
disabled, rely upon? According to two executives at the Mayo Clinic,
the main problem with the U.S. health care system is that it isn’t
a system.
In an essay entitled “America’s Ailing Health Care System” in
the April issue of Mayo Clinic Proceedings and reported by Newswise, Mayo’s
chief executive officer, Dr. Denis Cortese, and its chief administrative officer,
Robert Smoldt diagnose problems in U.S. healthcare and prescribe major reform
based on the new concept of the “Learning Organization.” To promote
dialog about the reforms they outline, the two executives are hosting a May symposium
at the Mayo Clinic.
The Diagnosis
Cortese
and Smoldt claim a “confluence of issues” needs
immediate attention and action. “Something [must] be done to
fix—not patch—the system. In reality there is no healthcare
system [in the U.S. today].” Although a myriad of professionals
and organizations currently provide healthcare, “no vision
has ever been articulated for these disparate parts to function together
and learn from each other.”
Dr. Cortese compares the problem in today’s health care system
to a disease of the human body. “As healthcare professionals,
we marvel at the complexity of the human body, extraordinary when
its systems perform in concert, devastating when disease or disorder
invades. One malfunction within the body, not making insulin for
example, may lead to serious problems such as blindness, peripheral
nerve damage and heart disease. Our job is to bring the entire human
body back into balance so the patient can lead a full productive
life. A similar holistic approach should be used to examine the way
we provide healthcare in the United States. Like a person suffering
from a debilitating disease, healthcare in the United States is ailing.
There are many signs that it is in serious trouble.”
Smoldt says current financial incentives are seriously misdirected. “Medicare’s
payment model creates a built-in financial incentive for medical
centers to provide more services, even though recent studies involving
patients with chronic diseases show no evidence that doing more improves
either medical outcomes or patient satisfaction. Reducing payment
rates for office visits has led to shorter, more frequent and less
effective appointments. Because their financial responsibility for
patients ends when Medicare coverage begins, insurance companies
don’t have financial incentives to best help patients over
a lifetime - especially if the costly complications are unlikely
to show up until [after] age 65.”
The Prescription
The core concept
for the reform proposal comes from Peter Senge’s
book, The Fifth Discipline. In it Senge describes learning organizations—places “where
people continually expand their capacity to create the results they
truly desire, where new and expansive patterns of thinking are nurtured,
where collective aspiration is set free, and where people are continually
learning to see the whole together.”
Mayo’s executives believe health care organizations need to
be transformed into such learning organizations in order to ensure
quality care in the future. “Health care as it exists in the
United States isn’t sustainable,” says Dr. Cortese. “Health
insurance premiums consistently increase faster than inflation or
worker earnings, 46 million Americans lack insurance, and the percentage
of employers offering health coverage dropped from 69% to 60% in
the last five years. Nearly half of physician care isn’t based
on best practices, and each year 98,000 Americans die from a medical
error. Five years from now, when the first baby-boomers qualify for
Medicare, we will be on the cusp of a crisis if changes aren’t
made.”
The authors say a new view of American healthcare begins with a common
vision of seeing health care providers as patient-centered learning
organizations that provide the best care at the right price, the
first time. Key elements of such a learning organization for healthcare
would include:
• Health care professionals in a learning organization should
expand their knowledge through perpetual education, pass on knowledge
through teaching or mentoring, and add to the body of knowledge through
basic, clinical or health sciences research.
• Physicians need training in engineering principles and partnerships
with engineers to improve the processes of care. One familiar example
of such a partnership is unified medical records, which long ago replaced
the practice of each Mayo physician keeping separate notes. About eight
years ago, Mayo began working with IBM to develop an electronic medical
record to collect, store, and retrieve data; distribute and analyze
information; and generate knowledge.
• All helpful information about an individual’s healthcare
should be available to physician and patient, anywhere in the world,
within seconds of pushing a computer key. Examples of such information
include medical and family histories, medication lists that automatically
check for potentially dangerous drug interactions, test results and
radiology images, best practices with links to the latest medical literature
and disease management strategies for the patient’s condition,
the individual’s unique genetic profile to individualize treatment,
and clinical trials for which the patient may be eligible. Unfortunately,
at present only 15% to 20% of U.S. physicians’ offices and 20%
to 25% of hospitals are using electronic medical records.
Cortese sites a recent
example of this shift toward making information widely accessible.
During the past 10 years, “Kaiser Permanente,
which provides healthcare coverage and medical care to more than
8.3 million members throughout the U.S., has invested $3.2 billion
in a comprehensive electronic health information [product]. The overriding
goal is to improve the quality of care. Once fully-implemented, patient
medical information and clinical decision support will be available
all the time, more than one clinician will be able to use a single
patient’s information simultaneously, and patients can more
easily participate in their own care. We must become team members.
The team approach fosters an ongoing analysis of the outcomes and
processes of care, a key step in any systematic approach to improving
quality care."
Getting There
The authors suggest
the learning organization vision for health care could be best
achieved through a “consumer-driven, market-based
model that delivers universal coverage to all Americans, a model
similar to the Federal Employee Health Benefits Plan (FEHBP) or the
Universal Health Voucher Plan. Relying on market principles can help
us achieve our vision for healthcare.” Within this model, providers,
patients, insurers and government must all modify their roles. A
market-based insurance model similar to the FEHBP, which functions
well for government employees, would ensure fair, universal access
to private insurance, with the government providing financial assistance
to those who need help purchasing insurance, they write.
“FEHBP … is affordable, offers choice, covers drugs, has
no state mandates and allows people the right to purchase more options.
Employers would not be required to provide health insurance, but, in
the interest of their business or employees, could choose to contribute
to the cost. Employees could use the employer payments to cover all
or part of the cost for any insurance plan on the national menu. The
federal government could coordinate these insurance offerings through
an organization like the Office of Personnel Management, which currently
runs the FEHBP at a relatively low administrative cost.”
Smoldt says the FEHBP model would enable the government to focus its
limited resources on those who need help, would preserve consumer choice
by enabling patients to be more fully engaged as the purchaser and
the customer, and would allow a dynamic private market more freedom
to provide the innovation and increases in productivity that can contain
health care costs. “It also would prevent people being excluded
from coverage because of a pre-existing condition, because all of the
insurance companies would be required to accept all patients during
the open enrollment period,” he says.
The authors believe patients should pay a portion of their care “so
they are aware of healthcare costs and can become better consumers.
Everyone must have health insurance that includes a basic benefit package.
This is a matter of individual responsibility and analogous to requirements
for individuals to have automobile insurance. The federal government
would help finance insurance for those who are in need."
Symposium
Scheduled
The authors stress the need
for many voices, not just theirs, to enter the reform discussion. “We also realize
that others have creative ideas about how to transform health care
in order to meet the needs of patients.” Dr. Cortese says it
is crucial that the discussion begins in earnest, and to that end Mayo
is hosting the Mayo Clinic National Symposium on Health Care Reform,
May 21-23, in Rochester
As Dr. Cortese concludes, “For true reform, and for a health
system that is truly a system, we need a common vision that can only
be developed through a national discussion. We look forward to being
part of that discussion, and hope to facilitate moving from discussion
to concrete action.”
Details are available
at www.healthpolicysymposium.org.
Dr. Cortese can be contacted at cortese.denis@mayo.edu
In his wheelchair in Jacksonville, FL, Herb Drill writes and edits
www.notaccessible.com and
is a charter member of the Society of American Business Editors and
Writers. His e-mail address is herbdrill@notaccessible.com
