Strategies to Advance Health Care Reform

1. Strategies to Advance Health Care Reform R. Scott Gorman, M.D. Mayo Clinic Center for Health Policy Vice-Chair, Executive Board Mayo Clinic Arizona

2. Purpose of Today’s Talk • Briefly review the history of health care reform in the United States • Review the key health care reform issues currently being debated • Discuss the pros and cons of a public plan • If Medicare-based? • If based on the FEBP or co-op plan? • Weigh options for the achievement of universal coverage • Consider how to fund health care reform proposals • Review the strategies to advance health care reform advocated by the Mayo Clinic Health Policy

3. Health Care Reform in the U.S. • A national health plan was initially proposed by Theodore D. Roosevelt in 1912 • Franklin D. Roosevelt proposed a national health plan as part of Social Security in 1935 • Some form of national health care reform has been proposed by every U.S. President since FDR • Significant past reforms include: • 1965 Medicare Act • 1973 HMO Act • 1984 Medicare DRGs • 2003 Medicare Part D

5. Health Care Reform in the U.S. • Why have previous health care reform proposal failed? • Unlikely coalition of interests seeking to maintain the status quo • Physicians • Insurance Companies • Pharmaceutical Companies • Business- especially small businesses • AMA • Hospital Association • Politicians • If you slow momentum, reform becomes less likely

7. Key Issues in Health Care Reform 2009 • How do we expand health care coverage? • How do we pay for it? • How do we decrease the costs of providing care? • How do we improve outcomes and the quality of care? • How do we overcome the disparities in health care?

8. Key Issues in Health Care Reform 2009 • Universal Health Care Options • Mandated insurance for all using • Private insurance-- either employer-based, individually purchased, or through vouchers with elimination of “pre-existing” limitations • Private insurance plus a “public plan” based on Medicare, Medicare-like, FEBP, or Co-op model (a state or regional non-governmental, not-for-profit, consumer-driven plan) • Single governmental plan probably based on Medicare

9. Key Issues in Health Care Reform 2009 • What is proposed to pay for universal coverage? • Remove waste / Improve practice efficiencies • Tax employer-provided health care benefits • Tax employers who do not provide coverage • Increase taxes, especially on the wealthy • Decrease ability to take deductions • Direct increase in income tax for those individuals/couples earning $250,000/350,000

10. Key Issues in Health Care Reform 2009 • How do we decrease the cost of providing care? • Proposed Methods: • Increased use of information technology • Provider payment decreases and redistribution • New payment mechanisms (capitation, bundling) • Manage Medicare • Evidence-based use of technology • Encourage preventive care • Care coordination through the “medical home”

11. Key Issues in Health Care Reform 2009 • How do we improve outcomes and the quality of care? • Pay for outcomes (quality, safety, service) and not just the volume of patients seen or procedures done • Coordinate care • Manage Medicare

12. Key Issues in Health Care Reform 2009 • How do we overcome the disparities in health care • Universal coverage • Education • Non MD coordinators of care (navigators) • Incentives

15. Mayo Clinic Health Policy Center • Established 2006 • Endorsed by Mayo Clinic Trustees • Developed “cornerstones” for health care reform after convening meetings with >2000 stakeholders from all walks of life– group as well as individual interviews • Representation in Washington D.C. and throughout the United States

16. Mayo Clinic Health Policy Center • Supports President Obama’s call for reform and the belief that “the status quo is not an option on the table” • Supports pay-for-value • Supports universal coverage in a form where individuals will have choice when selecting health insurance • Believes that Medicare is currently NOT a model on which to build a public plan- Medicare reform should be part of any health care reform package

17. Mayo Clinic Health Policy Center Four Cornerstones 1. Increase value in health care (Value equals Quality / Cost) • Measure what we do • Create, test, and deploy new payment mechanisms to help control costs • Improve outcomes while decreasing medical errors, cost, and waste

18. Mayo Clinic Health Policy Center Four Cornerstones 2. Improve coordination of care • Coordinated care improves care, decreases waste, and improves patient satisfaction • Use information technology to aid care coordination including self-management and other forms of non-visit care • Use incentives to encourage team-based care (have the right provider connected to the right patient at the right time) • Involve the patient, their family, and their community

19. Mayo Clinic Health Policy Center Four Cornerstones 3. Achieve payment reform • Provide incentives for improved care and better outcomes rather than just the volume of patients seen • Encourage Medicare and other payers to pay for innovation– get away from the fee-for-service mentality • Establish an independent health care board to help “de-politicize” national health care issues

20. Mayo Clinic Health Policy Center Four Cornerstones 4. Achieve universal coverage • Guaranteed, portable, basic insurance for all • Either individual or employer-based • Sliding-scale governmental subsidies to help those with lower incomes • Allow choice and allow people to purchase more services and insurance if they choose • Independent national health care board to establish basic insurance coverage and options

21. Additional Issues • Primary Care physician shortage • Sky-rocketing cost of medical education • Increasing number of physicians refusing to see Medicare patients • Cost of Medicare Advantage plans • Pharmaceutical issues • Lack of competitive bidding for Medicare • Disproportionate cost of R & D to U.S.A.

23. Discussion