There’s no turning back from health-care reform, Iowa Health System CEO Bill Leaver says. One year after President Barack Obama signed the reform legislation, a succession of GOP leaders is campaigning on a repeal of “Obamacare.” Leaver is leading Iowa’s largest health system onward through reform, adamant that cost- control parts of the law won’t — and must never — go away.
“I’ve heard Rep. (Steve) King and others says we’re going to repeal and erase,” Leaver told the Times Editorial Board Tuesday. “I don’t want that to stop. I don’t think the American people want it to stop.
“We have all these people involved in change. There’s a certain momentum. People are excited. They see something different that’s going to create better value for our patients.
“Whatever happens politically, we cannot continue to do what we have. We can’t afford it.”
Iowa Health System physicians, including some with Trinity in our community, are being schooled to lead new, coordinated care techniques. “Most docs are trained to rapidly assimilate data and come to a quick decision. We’re really asking them to coordinate care, and work in teams and groups and look at whole processes. That’s a whole different mindset for doctors.”
One goal is to compensate doctors and other providers for good outcomes, not services rendered. The new skills include advocating for patients’ long-term wellness, not just treating their ailments.
“Many people have said fee for service is dead. I don’t know that it’s time to write the obit, yet, but clearly it’s on the way out,” Leaver said.
Much of the emphasis is on reforming treatment and billing for chronic conditions, such as diabetes. Providers and patients working together to manage diet, weight and reliable medication can produce better outcomes than surgeons trying to fix a succession of diabetic ailments.
For some chronic conditions, patients and their insurers would be billed a flat rate for ongoing treatment plans, not for every visit.
“Over the long run, the focus needs to be less on facilities and much more on the system of care people are going to get,” Leaver said. “They pick and pay for system care based on value they perceive: price, outcome, the experience they get, the feeling they have someone helping them, a partner to navigate the system.”
Leaver acknowledges that’s a far cry from the health system that not so long ago marketed its plush birthing suites and premium cafeteria menu.
“Now the competition is around the price, the experience I’m going to get, the outcome I’m going to get, things other than who’s got the nicest looking facilities.”
Leaver champions those changes not just as political reform, but as survival. As costs continue to rise, and more Americans become eligible for Medicaid and Medicare, the future without reform is clear.
“Our view is you cannot sustain that. Clearly what was passed in Congress says we cannot sustain that level. We can’t print enough money,” Leaver said.
So where do the savings come? Leaver expects it when coordinated care keeps more diabetic patients out of surgery; when better managed diet and medicine reduces emergency room visits; and when patients know they can rely on primary care providers — not just doctors — to see them through treatment.
Trinity Health Systems Chief Medical Officer Dr. Paul McLoone offered this example on a joint replacement. The physicians and a patient’s insurer would know up front the flat rate for a knee replacement, from prep through rehab. “If there’s a complication that occurs... say the quality of the implant not as good, or something else that could have been done better,” McLoone said treatment will continue with no additional cost to patient or insurer.
“Doctors would know if there’s a complication to a procedure... they’re not going to get paid,” he said. “So there’s going to be more of an emphasis on getting it done right in the first place. So you pick the right implant for knee replacement, for the right facility and the right length of stay in the hospital that optimizes the outcome. You optimize the quality so the total cost is less.”
Leaver said fixing costs on common procedures like joint replacements can lead to another revenue stream.
“You begin to think about medical tourism. Actually, we’re talking to a company with a lot of employees in New York City. Think about it. We can probably do their hips and knees at half the price. Now you begin creating some competition.”
Even if Congress tinkers with the insurance mandate or eligibility for government-paid plans, Leaver said his organization’s cost-control initiatives will proceed.
“My message to our folks in our organization is full steam ahead. Whoever is controlling Congress or the White House is going to need the ability to control costs. These are the best demonstrated ways to do that.”