Politicians in Washington, D.C., and St. Paul will be engaging in spirited debates over health care policies in the short and long term. To shed some light on key issues, Twin Cities Business sought perspectives from Minnesota health care leaders.
Specifically, we asked them what they would do to make health care delivery more efficient and boost patient outcomes. Health insurance affordability was a huge issue in the 2016 election, and Minnesota’s health care leaders are thinking about ways to better address cost and access concerns.
What follows are short commentaries from physicians and other health care industry leaders. Their responses have been edited for length and clarity.
—Liz Fedor, Trending Editor
Jim Eppel | President and CEO, UCare
Increase prevention and collaboration
Greater efficiency: We need the health care system in this community to behave and perform more like a system. That means defining how and where we compete and, more importantly, the most productive opportunities for collaboration to benefit the members and patients we serve.
There are many critical areas where we can work together to have positive impact for individuals and families. These areas include a collaborative approach to issues such as opioid addiction, obesity or pre-diabetes—all true health crises in this country. We need to go “upstream” by providing greater funding for prevention rather than solely focusing on treatment. We can reduce the waste and inefficiency associated with unnecessary duplication by sharing data to a greater degree. As in other major markets, Minnesota has significant duplication of expensive technology operating at less-than-maximum capacity.
Endless opportunities exist for providers, payers, purchasers and patients to work together. We must identify them, choose our areas of focus—and get started.
Better patient outcomes: First, we must define “good outcomes.” The patient’s definition of a positive outcome often focuses on the process of care and may or may not correlate with the clinician’s definition. We need to do the hard work of identifying the criteria for measuring outcomes and focusing on functional status, lack of complications, clinical improvement and quality-of-life issues.
One thing we all can do is return the patient to the center of the health care universe. Patients should receive the education they need to make wise health care choices, along with necessary and relevant data, such as cost, clinical quality and practitioner experience. We need to create incentives that encourage informed decision-making, as well as incentives that recognize—and reward—patients who demonstrate that they are doing everything they can to optimize their health.
The health care system as a whole also needs to take the long-term view. We must stabilize the insurance market so that patients do not continually worry about access to affordable coverage and care. Short-term decision-making must be replaced with a willingness to “invest” today for a return beyond the current financial cycle.
Many would argue that today’s health care system is in need of significant overhaul. This is a great challenge—and a great opportunity. I am confident that in this community we have the experience, expertise, tools and commitment to successfully tackle this important work together.
Dr. Robert Nesse | Senior Medical Director, Payment Reform, Mayo Clinic
Value over volume
Greater efficiency: Efficiency, quality and sustainability are all interrelated. Mayo has long believed that a focus on improving quality will improve efficiency, and as we move closer to a value-based health system, it will enhance sustainability. In addition, the application of systems thinking in health care delivery, informed by engineering principles, can also improve efficiency and quality. Mayo is committed to the application of systems engineering processes and methods to our continuous quality-improvement efforts. Working side by side with engineers has helped improve both the efficiency and outcomes of care delivery.
We strongly believe in shifting the health care delivery system to one that rewards value over volume or production. The incentives embodied in fee-for-service are counter-productive. From a provider perspective, the fee-for-service claims-based system does not provide the critical clinical and financial insight to drive improved efficiency and clinical outcomes.
Measuring and reimbursing for value is a dramatic change—a major disruptor—for the health care system requiring changing incentives, defining the most appropriate, relevant, accurate and properly differentiated metrics of quality and efficiency of care. However, this level of disruption is necessary to accomplish the triple goals of improving efficiency, quality and sustainability of the system. Mayo Clinic supports a value-based health care delivery system while understanding that much has to be done to ensure its success. But it is in the best interest of patients and the sustainability of the health care system.
Better patient outcomes: Improvement of patient outcomes is a relentless process. It requires a commitment to continuous quality and efficiency improvement. It is best done in the context of a value-based health care delivery system—one that rewards value over volume. Finally, the continuous improvement must be and can now be informed by the increasingly sophisticated products of health sciences research.
Mayo’s Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery is producing research that provides data-driven transformative methods to improve clinical practice, resulting in higher-quality, improved clinical outcomes for patients.
Combining data analytics, health care engineering principles and advanced modeling, the Center for the Science of Health Care Delivery rigorously tests theories, clinical practice models and methods to determine how to improve patient care, outcomes and efficiency. The work of the center has been published, diffused and incorporated in practices across the country.
Dr. Jon Pryor | CEO, Hennepin County Medical Center
Make health care convenient
Greater efficiency: First, all health systems should embrace lean management, which is about getting rid of waste and improving efficiencies. “Lean” is a set of simple concepts and is founded on the principle of continuous improvement. There are several health systems in Minnesota that embrace lean, including HCMC, but all systems could and should put lean management into practice.
Secondly, we need to make medicine more efficient for the patient, not the health system. Too often clinics are closed when a patient gets off of work. If it is too inconvenient to see a provider, unless the issue is emergent, many people just don’t go and delay the care they need to stay healthy. We should have more evening and weekend hours and allow more of medicine, when appropriate, to be done over the phone. This is referred to as telemedicine; it would require paying the provider for services over the phone, but would both save money and deliver health care to the home and workplace, and specialty care to local rural hospitals.
Better patient outcomes: Sometimes we practice the art of medicine when it should be the science of medicine. When we have good evidence on how to do certain procedures or when not to do things, we can be more consistent in following the evidence-based guidelines. For example, we know when central lines are inserted and taken care of on a daily basis in a standard and specific way, the central lines virtually never get infected. Yet sometimes we don’t follow these standards on a consistent basis and that could lead to an infection. That can lead to bad outcomes and is costly.
Another example: We know that we should not be giving antibiotics for colds caused by viruses, and yet there are still providers who prescribe antibiotics for the common cold. Endorsing a culture of following evidence-based medicine, educating our patients on why we treat using evidence-based care, hardwiring the right way to do things in the electronic medical record so it is difficult to deviate from evidence-based care, using checklists (as in the airline industry) to help us remember to follow accepted standards, and auditing to make sure standards are being followed are all ways to make sure our patients get the right care each and every time. That will improve outcomes.
Donna Zimmerman | Senior Vice President for Government and Community Relations, HealthPartners
Care: in-person and virtual
Greater efficiency/better patient outcomes: As an integrated health care organization, HealthPartners provides both health care coverage and care throughout our region. Unfortunately, we see that for a lot of people, the health care system doesn’t work as well as patients need it to. Real improvement is about achieving the triple aim: Providing high quality care and an exceptional experience while also making care more affordable. We’re working toward this in a few different ways.
We’re changing the way care is paid for. We’re using value-based payments, packaged pricing and “total cost of care” approaches that are based on health outcomes and quality of care. Bundled payments for knee or hip replacements are one example. These approaches support greater transparency and they provide members with cost and quality data to make more informed decisions.
We’re investing in new models of care that improve health and reduce cost. Patients want 24/7 care that is convenient for their lifestyle. To meet these needs, we have to keep expanding the options for members and patients to receive care—in person and virtually. For example, we’ve had over 200,000 visits through virtuwell.com, our 24/7 online clinic, and have established more than 20 clinics at worksites.
At the same time, we need to help consumers understand how each of those options affects the cost of their care. We’ve focused on using measurement tools like the total cost of care to help members choose the care they need, and how and when they need it.
Lastly, we’ve been exploring personalization, where we reach out to members with messages tailored specifically for them. One example is mammograms, which can detect breast cancer in its earliest, most curable stages. But too many women aren’t getting mammograms—and for a variety of reasons.
So we used data to develop three categories of messaging that those women could relate to. One focused on age, another spoke to convenience and affordability, and a third presented mammograms as evidence-based and doctor-recommended. Through that campaign, 551 additional members got their mammograms in a two-month period.
By reaching out with messaging that resonates, we can more effectively change behaviors, encourage better health and, in the long-term, lower costs.
Health care needs to be simple, available and affordable. By partnering with our members, patients and community, we can solve these challenges.
Kathryn Correia | President and CEO, HealthEast Link mental health, primary care
Greater efficiency: Keeping patients and communities at the center of everything we do is foundational to our obligation as a health care provider. Our strategies align with this obligation and align our work. Focusing on a culture of continuous improvement assures we remain relevant regardless of the direction the market takes.
Effective prevention and treatment depends on convenient access to and coordination of services, and it is critical that behavioral and mental health services be linked and aligned with medical prevention and treatment. Our community’s care model could be greatly improved if mental health services were effectively linked with primary care and if outpatient behavioral services were aligned and coordinated with the full care continuum.
To be effective, mental health care must be provided in a way that is culturally appropriate. Focus should be on preventing hospitalization by meeting the needs of people experiencing mental illness before it becomes a crisis. We are addressing those needs in part by integrating mental health care into primary care. In our clinics we have co-located psychotherapists and are also expanding inpatient capacity for unmet needs.
Better patient outcomes: Many downstream health care costs are directly linked to social determinants of health in communities. We are committed to working with communities, where many people are struggling with the cost of health care, as well as with access to healthy food and physical activity.
We see the benefit of engaging local organizations to impact these aspects of health and understand that work at this level can decrease downstream costs and improve health outcomes. Our biggest challenge will be continuing to reduce the burden of medical care as we work in partnership with patients and our communities to improve health and well-being.
We need to be aware of our customers’ continually evolving expectations and be nimble enough to change processes to deliver care when, where and how it is desired.
Garrett Black | Senior Vice President of Health Services, Blue Cross and Blue Shield of Minnesota Better information flow
Greater efficiency/better patient outcomes: Stakeholders must work together to curb information gaps. Consumers, providers and health plans are not equipped with all the right real-time information to make informed decisions. When medical information is fragmented and kept in separate silos, costs go up and effective care coordination suffers.
For example, when a person sees different doctors at different clinics or hospitals, those doctors can’t see “the big picture” on where else that patient has been, accurate medication lists or recent admissions and treatments, or what their complete health history looks like. This partial view leads to unnecessary duplication of services such as lab tests and scans, increased risk of medical errors and wasted time for the patient and caregiver.
One solution is to create a health information exchange in Minnesota that would connect different electronic medical records between providers and with health plans. This process would improve the sharing of important clinical information, increase transparency on provider performance and would enhance the patient experience by allowing people to make more informed choices.
Bob Bonar | CEO, Children’s Minnesota
Greater efficiency/better patient outcomes: In pediatrics specifically, we need to look at redundancy in the marketplace. [The focus is] on eliminating non-value-added duplication of services, which reduces efficiency, hinders safety in some instances, does not necessarily produce better outcomes, and prevents the building of any scale, thus is more costly.
It is important to develop a single comprehensive pediatric health care system that is integrated and academically oriented. It would have cogent population health practices, top-notch coordinated research, and a laser focus on providing the best possible outcomes in the safest environment. It would make a huge difference in the quality of health care services for children in both the Twin Cities and the entire state of Minnesota.