Speakers optimistic about future of health care

The Supreme Court is expected to rule in June on the constitutionality of the Patient Protection and Affordable Care Act, President Obama’s signature legislation. The likely Republican presidential candidate has vowed to repeal the legislation, dubbed Obamacare by its critics. And with spiraling costs, health care has become a hot-button issue in Congress, rendering uncertain the act’s fate. Nevertheless, two keynote speakers at a Yale conference in April said there is reason for optimism amid concern about the future of health care.

Neither Karen Ignagni, president and CEO of America’s Health Insurance Plans (AHIP), nor Bernard J. Tyson, president and COO of the not-for-profit health care giant Kaiser Permanente, hazarded a guess on how the Supreme Court would rule. But both offered suggestions for cost containment: streamlining delivery, using computers and smartphones to get patients more involved in their treatment, and having frank public discussions about the effects of spending on the national debt. Providers and insurers, they said, also need to reduce unnecessary procedures encouraged by fee-for-service systems, and enroll younger and healthier people to defray the costs of a minority of patients who consume the majority of health care dollars.

The two spoke at Yale HealthCare 2012, the eighth annual conference organized by students of the Schools of Management, Medicine, Nursing, and Public Health to explore the intersections of health and public policy. This year’s conference, “Innovation in Healthcare: Forging Transformative Solutions,” explored solutions to the most pressing challenges, especially fiscal ones, facing the United States and global health care systems. Panels of health care and management professionals discussed personalized medicine, innovations in quality assessment, optimizing employee health care consumption, and technology and the future of health care.

Both keynote speakers acknowledged that health care has become a polarizing political topic. Ignagni said that Washington ignores such issues as health insurance costs for small employers and individuals as well as the effect of hospital consolidation in most of the major markets. “If you talk to members of Congress about it, it’s like crying ‘Fire!’ in a crowded room,” she said.

Cost management is another painful topic, said Ignagni, who leads the chief advocacy group for health insurers. “People run out of the room very quickly,” she said. “My cost containment is somebody else’s revenue reduction.” But Medicaid spending rose from 11 percent of state spending in 1987 to 24 percent in 2011. “How long can that continue?” she asked.

One piece of the solution, Ignagni said, is to redesign health care delivery “to not focus on body parts but to focus on the whole patient.” Providers must “empower” enrollees to take a bigger role in maintaining their health. Her health plan reminds her to refill her asthma prescriptions, she said. If she doesn’t, she said, “I will end up in the E.R.”

Kaiser Permanente likewise contacts patients—especially high-risk patients like diabetics—who haven’t had an exam in a year. “All my medical information is in my pocket,” Tyson said, noting that Kaiser Permanente, a prepaid system with 9 million members, has embraced electronic medical records to connect providers and patients, and mobile technology to integrate health into daily living. In an emergency, “all your password-protected medical information is on your phone.” A connected, integrated system like Kaiser Permanente can focus on disease prevention by encouraging outpatient services and virtual visits. “You can be in your living room or on the beach” and still get advice, he said. In 2011, Kaiser Permanente members sent 12 million e-mails to their providers, viewed 29.7 million lab tests online, and had 132 million prescriptions checked for drug-to-drug interactions and allergies electronically.

Still, Tyson said, there is too much waste in health care. The United States spends more per capita on health care than any other nation in the world, yet, the cost of care is not equivalent to our health care outcomes.

Approximately 25 percent of care dollars are spent on acute care and 75 percent on chronic conditions with between 10 and 20 percent of patients consuming 75 to 80 percent of health care dollars, especially in the last years of life. “High quality and improved quality can indeed bring costs down,” he said. Connected care can also improve care and help the industry address the 100,000 people in the United States who die each year while in America’s hospitals—the same as if “a fully loaded 757 drops out of the sky every day.” With an integrated electronic medical record system, health care workers will know how a patient should be treated and don’t have to “make it up.” The up-front costs of Kaiser Permanente’s system were high, but they are paying off, Tyson said. “I don’t want to leave you with the impression that we have figured it out,” he cautioned. “While we have made tremendous strides in quality improvements, we have not yet arrived.”