Government vs Market reform - Systematic Reform of U.S. Health Care – One Man’s Meat

I’ve been reading George Halvorson’s new book Health Care Reform Now! (Wiley, 2007). Halvorson is chairman and CEO of Kaiser Foundation and Hospitals, a $35 billion health plan in Oakland, California. Kaiser has invested heavily ($3 billion) in a system-wide EMR and in targeted improvement of 5 chronic diseases – diabetes, asthma, coronary artery disease, CHF, and depression - which consume 70% of U.S. health care dollars.


Halvorson thinks of U.S. health care as a disorganized colossus that needs to be reorganized under a national corporate umbrella with systematic gathering of data, process re-engineering, continuous improvement, and infrastructure vendors who put the delivery of care up for bids.


He envisions an ideal health care system patterned after General Electric’s Six Sigma improvement model. His view isn’t my cup of tea. It makes doctors functionaries of large health care organizations, threatens private practice, and restricts physician freedom. Still it’s a view that needs to be understood.


Halvorson says eight developments make reform imminent.


1. A Common Provider Number – All doctors will soon have a single number identifying each individual doctor for all payers and all care. The number can be used to track your performance nationally. Halvorson states “Health care reform becomes possible when we have real performance data about care.”


2. Computerized Databases – All payers have computerized data bases. All databases are standardized and electronic. This assures uniform data flow and can be used to track each patient’s incident of care.


3. Electronic Claims Data Portability – You can transfer data between health plans just as banks can transfer data. Halvorson says this is a “data bonanza for health care.” Data transfer creates databases for each individual patient and each doctor, Further, community databases can track patterns of care and caregiver performance.


4. Government Transparency about Payment Data - Halvorson says government’s willingness to share Medicare and Medicaid data is a huge transparency step forward because you can now compare physician performance.


5. Universal Awareness of Quality Issues – Halvorson says widespread awareness that the health care infrastructure is “badly flawed, perversely incented, inadequately coordinated, incredibly inconsistent, strategically unfocused, and too often dangerously dysfunctional” will facilitate reform.


6. Buyers Are Ready for Change - Halvorson believes primary buyers of care – government and employers – are ready for change. There are no “happy buyers,” he asserts, and employers are cutting benefits, and markets and industries are ready to try anything that works.


7. Internet Functionality Used for Care - In purchasing, banking, investing, and education, the Internet has made “massive inroads into how we do business.” Halvorson foresees e-scheduling, e-visits, e-follow-ups, e-reports, e-reminders, e-consults, and e-home visits. Halvorson says, “Paper can’t do the job. We need the web to reform care.” The Internet could make an e-normous difference if only we could weed out e-relevant misinformation.


8. Lawmakers are Ready for Reform - Halvorson cites 20 states - California, Colorado, Connecticut, Florida, Hawaii, Kansas, Illinois, Maine, Maryland, Massachusetts, Minnesota, Missouri, New Hampshire, New Yoke, Ohio, Oklahoma, Pennsylvania, Rhode Island, Vermont, and Wisconsin – that have introduced State Health and Universal Coverage Initiatives.


Fourteen states – Kansas, Kentucky, Massachusetts, Michigan, Minnesota, New Jersey, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, ashington, and West Virginia – have mandated employer health insurance coverage.


And one state. Massachusetts has imposed a “free rider surcharge” on employees who don’t provide coverage.


Wrap-up

It’s possible a single provider number, data from EMRs and PHRs and retrospective claims , data portability, and payers seeking change will make for real health reform soon. It’s possible data-based large virtually integrated groups, acting synchronously and strategically, focusing in continuous improvement, will bring about reform.

But it’s unlikely, given the reality that 90% of America’s doctors now practice independently, mostly in small groups. It would require a massive physician cultural shift. But likely or not, Halvorson insists the technological and management tools are there, and it is “doable.”


I find Halvorson’s vision Orwellian. He is saying in the future Big e-Brother will be watching you. What Halvorson says may be logical, but it frightens me because it compromises the freedom of American physicians and patients..


What do you, America’s independent practitioners, think of Halvorson’s vision? Is it doable? Is it desirable?