Building Blocks of Health Care Reform

By Mary Branham Dusenberry

Reforming the health care system won’t be easy, speakers at a workshop on the topic said Sunday.
But everybody knows change is coming as Congress considers options at the national level. In fact, some of those changes have been implemented as President Obama signed the Children’s Health Insurance Program Reauthorization Act Feb. 4.

The goal—getting more people insured—is admirable, Joan Gardner, executive director of State Services for Blue Cross Blue Shield, said. But plans for a national exchange, she said, could create problems. A government-run plan would create an uneven playing field between that plan and those provided in the private sector, she said.

But she acknowledged that changes need to be made.

One option is a public-private partnership, similar to one offered in Kentucky. The provider-sponsored Passport plan is offered to residents in 16 Kentucky counties through a Medicaid waiver, said Shannon Turner, executive vice president of University Health Care Inc. in Louisville. Because the physicians and hospitals are guaranteed a certain population of patients, Turner said, the patients have many choices for medical care.

This hybrid approach to coverage is one gaining interest.

“If everything had been working well, I don’t think we would be looking at a government program,”

Sen. Carolyn Allen of Arizona told panelists during the Q&A session. “I don’t want to run private insurers away, but they have problems that brought us to this.”

Gardner said her company, which offers coverage in all 50 states, supports a requirement that everyone carry insurance coverage.

The goal, speakers said, is to lower the cost of health care. That can be accomplished through evidence-based practices, said Dr. Martha Gerrity, clinical evidence specialist for the Medicaid Evidence-based Decisions Project at the Oregon Health and Science University.

The center works with 12 states; those states have saved between $7 million and $80 million using research to determine what practices work best and more efficiently, according to Gerrity.

Both Turner and Gardner support research into solutions that works. And altering the health care system to incentivize wellness—instead of treatment—will take time, Turner said.

“I think we need to spend a little more time looking to provider community for input,” she said.

Gerrity predicted states will begin to face even more challenges in their Medicaid programs as advocates and the industry press for more services and the poor economy creates even more need for such services.

Comments

[Stan J]

Personally I would like to go with something like they have in many European countries. There is the single payor government healthcare program plus you can go to a private doctor/hospital if you so wish. I found it worked very well when I was living in Spain.