Wednesday, November 19, 2008

Priorities

How do Wellpoint (Angela Braley, President and CEO), Pfizer (James Kindler, Chairman and CEO), Mayo Clinic (Denis Cortese, MD, President and CEO), and Novartis Pharmaceuticals (Daniel Vasella, President and CEO) see fixing health care? Here are the talking points from the Wall Street Journal's CEO Conference discussing their priorities for the Obama administration (with a few of my thoughts in italics):
  • Use the "bully pulpit" to fix obesity.
    (Nice. Tell people to stop being fat. I'm seeing an efficient use of resources here, aren't you? And clearly this job is too difficult to take on themselves: make this the focus of the surgeon general and be sure to increase the PR spin about obesity.)

  • Tort Reform - use the vaccine model to reduce malpractice.(Best of luck. Remember, it's the lawyers who write the playbooks.)

  • Define and Measure Value - define and measure desirable outcomes for most common diseases
    (Look for more check lists and "quality measures" to be tracked)

  • Payment Reform - Reward preventative care and evidence-based care (can you say more P4P?) and no longer reimburse inappropriate, unnecessary, or wasted care.
    (In other words, continue covert rationing efforts and care denials as well as renewed efforts to "discover" waste, fraud, and abuse in the system.)

  • Build Health Care Workforce - Focus on primary care, increase registered nurses, nurse practitioners and allied health professionals, and oh, (they almost forgot) doctors.
And when asked to "rank their priorities" of how to begin, we find that health care reform is (fortunately) way below the economic stimulus efforts underway. But when pressed on setting priorities for the new administration, they recommended the following:
  • Define value, reform payment as their initial focus.
    ("Value?" Value to whom? The Insurers? Pharmaceutical Industry? Hospitals? The Government? Or are we really talking about patients here? What does "value" mean when the term is used with CEO's with such varied biases? I suspect that payment reform is more the real goal here: basically pay providers less and let Americans continue to shoulder more of the health care dollar. If not, what specifically does this mean? Could we PLEASE stop the spin?)

  • Next, tort reform.
    (This would be nice, but why have prior efforts failed? Will plaintiff's lawyers agree to caps on damages? If so, how much?)

  • Fight obesity.
    (Sorry, but to spin this as the way to cut health care costs seems disingenuous. Like this is an easy issue to fix. The psychologic and sociological issues surrounding obesity are WAY to complex to suggest that government can fix this problem. Are Starbucks, Panera, Burger King, McDonalds, and every gas station quick-mart going to just sell salads and whole grains? I don't think so. Certainly, some help with EDUCATING the populace is always important, but as it is, I've never met an obese person who wasn't aware of their problem and wouldn't prefer to be skinnier. While noble in intent, practically I find this effort a distraction to fixing our health care crisis. After all, people MUST eat. They DON'T have to smoke. What about banning ALL tobacco products and tax the heck out of alcohol? Why not stop all pharmaceutical and medical device advertising tomorrow to SAVE MONEY? These measures would save billions instantaneously without one bit of downside to the populace. Heck, the evening news might even be nice to watch again...)

  • Finally, build the health care work force.
    (Let's see, it takes four years for medical school after college and two years for nurses... look for ancillary health providers to play an increased role in health care delivery. There is no question that more efficient care and information transfer can exact huge savings, but that government will have to step up to equip our health care network with the equipment to do so.)
There's lots of low-hanging fruit that can be addressed to begin to fix health care today. It's nice to know that corporate America is trying to struggle to address these issues. But I always find it interesting that when health care is the issue, government reflexively turns to corporations with their own vested interests to shape policy, rather than turn to the front lines for answers.

Maybe that should be priority one.

-Wes

1 comment:

Keith Sarpolis said...

Hi Wes,

As health care has become "big buisiness", in have swooped the managerial level that have leargely controlled the direction of medicine, and as expected, it is driven by profit pure and simple. After all, the goal of the CEO of any health care entity is growth and profitability with efficiency and cost effectiveness not even on the radar. So that is why you always see our "health care leaders" who dwell in their ivory towers always preaching what changes they see as important.

Physicians have turned the health care system over to these profiteers, much like our financial system that is now collapsing around us was turned over to people with similar mandates (profit and growth). The consequences will probably be the same as each entity looks out for its own self interent without consideration for the bigger picture of whether the whole process is sustainable in the long run.

Pysicains need to regain some control to at least balance the interests of business and bring some modicum of humanity back to medicine, which is evolving to resemble the big box store model of health care delivery.