Health-care reform advancing through Congress is fixated on access -- an admirable goal that all Americans receive the care they need. But affordability will suffer for employers and employees alike unless we focus on improving quality. As costs continue to increase, we'll lose the very thing we sought: access.
Minnesota has been recommended as a model for federal health care reform for good reason. Round 1 of our efforts occurred in 1993 when MinnesotaCare was created. The focus was almost exclusively on expanding access. Round 2 began in 2008 and became a necessity when Round 1 failed to create an affordable system.
Gov. Tim Pawlenty's recent announcement of his 2010 legislative package assures that quality remains at the forefront -- initiatives ranging from allowing interstate competition for insurance to pricing services based on quality and cost.
Federal policy-makers should heed the lesson and Minnesota's experience since 1993.
Healthier people are the most obvious result of focusing on quality. Affordability and care expanding access are right behind. Various studies estimate that 20 percent to 30 percent of the care we receive is either unnecessary and/or ineffective. That care is expensive as is the additional care that it triggers when "complications" result from a test or procedure that was unnecessary and/or ineffective. Focusing on quality gives us the resources to achieve and sustain universal access.
The recipe for higher quality, and therefore lasting reform, has four parts:
- A payment system that pays for results, not procedures.
- A patient information system that makes the effectiveness and price of a treatment plan and/or specific procedures easy to access, understand and use.
- A record system that's digital, portable and connected.
- An insurance system that's competitive and covers everyone all the time.
Payments: Changing to a system that rewards results is easier said than done. It will require health care professionals to define success relative to everything they do -- a monumental effort that will take years. But, if they begin with the most frequent diagnoses and/or the most common chronic conditions, thousands -- perhaps millions -- of Americans will be healthier, and we'll save money.
Information: Once providers identify what works, each should put a price on it and report their outcomes when delivering the prescribed care at the stated price. Then consumers or their representatives -- usually their employer -- can shop for the best value.
Records: It ought to be as easy to access my health history as it is to get my credit history. Electronic records will save time and money, and likely be more complete. Protecting privacy will be a challenge with a digital and portable system, but not an insurmountable one.
Insurance: Federal reform should define the rules for a nationwide competitive market. These must include mechanisms for sharing risk across health plans so all Americans can be covered all the time, regardless of their health. Continuous coverage is critical to quality. It translates into timely care for everything from vaccinations to chronic conditions.
To date, "universal access" has been the mantra of federal health care reformers. But access does little good if care is not affordable. The experiences of Minnesota say that focusing first and foremost on the quality of care will not only achieve these goals, but will do so in a way that's sustainable. On that basis alone, the reformers must focus on and put improving the quality of care first and foremost.
William Blazar is senior vice president of business development and public affairs at the Minnesota Chamber of Commerce.