The conference ended with a stimulating roundtable discussion among Bruce Auerbach, president of the MMS; Cleve Killingsworth, chair and CEO of Blue Cross Blue Shield of Massachusetts; Donna Cupelo, New England Region President of Verizon, and Paul Levy, President and CEO of Beth Israel Deaconess Medical Center. The moderator is Jim Braude from New England Cable News.
State of the State of Health Care Conference: 2008
Elliott Fisher, MD, from the Dartmouth Institute for Health Policy and Clinical Practice, said solutions that focus on changing individual physician behavior will provide only limited benefit. He said lasting solutions must focus on the role of the underlying local health system as the driver of cost and quality. A better approach, he offered, is to develop “local delivery systems" that are accountable for the overall cost and quality of care.
Susan Dentzer, editor in chief of Health Affairs, reviewed the literature on the causes of rising costs and suggested solutions. According to Dentzer, why are costs rising?
- advances in medical technology
- poor health status, especially obesity
- poor productivity
- no competition on prices
- Fee for service penalizes those who re-engineer their practice
- NOT: aging population, or malpractice costs
Solutions? Dentzer explored two approaches – from the Commonwealth Fund, and the Center for Studying Health System Change. These include:
- expanding health IT
- employment comparative effective studies
- patients sharing in decision making
- disease prevention
- realigning incentives
- correcting price signals, such as re-setting Medicare Advantage rates, and permitting negotiation of Medicare prescription drug prices
- payment reform – fee for service is toxic to health care
JudyAnn Bigby, MD, Massachusetts Health and Human Services secretary, kicked off the conference with persuasive evidence that Massachusetts has achieved a great deal in expanding access. But she also pointed out the persistent disparities in health care access for minorities. She touched broadly costs and quality, offering that payment reform, expanded health IT and transparent health care information are needed to address those issues.
She also raised questions about the mismatch between the large numbers of licensed physicians in Massachusetts and the persistent shortages cited in MMS physician workforce studies. “Why the paradox?” she asked. “It’s not simply a numbers game.”