Mayo CEO: Insurance Reform 'Easy Part;' Health Care Reform that Delivers Value 'Hard Part'
September 19, 2009 | By Lorna Aldrich | Lorna2@verizon.net
“Value” was the watchword for Dr. Denis Cortese, president and CEO of the Mayo Clinic, in his analysis of insurance and health care reform in the U.S. during his Luncheon address Sept. 18.
He distinguished between the “easy part” of reform – health insurance – and the “hard part” of reform – health care delivery. Health care delivery must be improved to create value, he said, or else we will “get everybody insured in a really bad health care delivery system.”
Cortese advocated insurance that individuals could “own,” meaning that it would be portable, not dependent on a particular employer. Insurance, in his view, should be mandated for individuals. He added that employers should not be required to provide it, although they could offer insurance as a way of attracting workers if they wished. Insurance, he said, should take all comers without reference to status or pre-existing conditions. He envisioned two roles for government in health insurance: as a funder and as a regulator of the insurance industry.
He said the Mayo Center favors something like the Federal Employees Health Benefits plan, which offers a wide range of private plans that can cover drugs. Perhaps, he said, there would be government subsidies and individuals could be free to buy higher coverage if they wished.
As for the “hard part,” health care delivery, Corteste defined “value” in terms of outcomes for the money spent. Positive outcomes, he said, keep people out of hospitals and reduce suffering from chronic conditions. Integrated, cooperative care produces good outcomes, he said.
Using a personal story about his mother, he contrasted her care for six years in Philadelphia, where she saw seven physicians who did not interact, with her care later at Mayo, which was integrated. After going in the hospital once a month for six years before she had integrated medical care, she went in the hospital once in the following six years. Success, he declared, would close hospital beds.
Cortese said there are states, cities and regions that produce good value. He listed their characteristics as higher levels than elsewhere of these traits: focus on the patient, physician engagement in change, teamwork and collaboration in medical decisions, sharing of medical records and information and a high level of “system engineering,” paying attention to the flow of the patient through the system. He singled out Hawaii, Iowa, Nebraska, New Hampshire, Minnesota, Rhode Island, Utah, Vermont, Wisconsin and both Dakotas.
But, he said, the “bad news is it does not pay to be good,” because incentives are not aligned. “We make more money the sicker you all are” he explained.
The highest cost of medical malpractice, Cortese said, is not that it raises medical costs but that it prevents learning because mistakes are hidden, not communicated. He contrasted the medical situation with airline regulations, which require reporting near-misses. These, he said, can be investigated and lessons learned and communicated to the rest of the system.
On the contentious end-of-life issue, he offered a value measure: how did the family feel about the process? In a patient oriented system, he said, that would be the standard. He also noted that the situations that produce higher family satisfaction are those that involve fewer procedures and cost less.