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Policy Talk Tries Shifting Conversation About Who Pays for What in Healthcare

Allison Inserro
We have been living in a groundhog world for the past several decades when it comes to healthcare spending, said Robert Dubois of the National Pharmaceutical Council (NPC) during AcademyHealth’s National Health Policy Conference, in Washington, DC. The session called When Are We Going to Get Serious About Health Care Spending in the United States? came a few days after the NPC launched an effort to have a dialogue around this issue by issuing a call for research around the topic and partnering with Health Affairs on a campaign called Going Below the Surface.
 
He also questioned if 1 solution would work for everyone. Like other presentations at the policy conference that cited last week’s Amazon­­–JP Morgan­­ Chase–Berkshire Hathaway health partnership, Chandra said he could imagine a white-collar financial services worker willing to pay more than a blue-collar hourly warehouse worker for healthcare for more expensive, innovative treatments. Income inequality will make this question harder to answer, he said.

It’s important to start asking the right questions, Chandra said, and ask about the value of our spending.

“Unable to say no to low-value care, we create powerful incentives to produce even more low-value care,” which leads to other ramification, he said.

Low-value care decreases our ability to deliver on other priorities, like social determinants of health. And then we struggle with being able to afford high-value interventions because we don’t know what to do.

Another panelist, Donna Cryer, president and CEO of the Global Liver Institute, talked about the issue from the patient perspective. “Patients don’t separate health from healthcare,” she said.

“Without health, children can’t go to school,” she noted. “We’re seeing our armed forces readiness being impaired by obesity and other chronic diseases.”

She said that health outcomes depend on just a small part of medical care given inside a provider's office and noted that in other countries, it’s helpful to look not just at what what they spend on healthcare but also on all the other factors that contribute to better health outcomes.

The final panelist, Glenn Steele MD, PhD, talked about his experience as head of the Geisinger Health System from 2001 to 2014 and how he is seeking to replicate those experiences elsewhere.

“If you want to change the behavior of the patient ... the single most interesting lever on that is through the provider,” he said. Geisinger focused on the primary care relationship between patients and healthcare providers, especially when it came to what Steele called the “redistribution of resources.”

“We would pay orthopedists less so that we could pay primary care providers more,” he said.

Geisinger also focused on educating staff on better outcomes and translating best practices into lower costs of care.

Steele now leads the Healthcare Transformation Alliance, made up of 47 large employers looking to share data on costs and outcomes, and will be looking at inappropriate utilization trends. He said they are creating a provider network and relationship with pharmacy suppliers. Currently operating in Chicago, Dallas, Fort Worth, Phoenix, Steele said it will expand to 5 more markets next year.

 
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