Symposia

Mayo Clinic National Symposium
on Health Care Reform

Executive Summary

A New Vision for Health Care
More than 300 national leaders representing business, health care, government,public policy and patient advocacy convened for Mayo Clinic's first National Symposium on Health Care Reform. The goal was to begin to reform the "nonsystem" of health care in the United States into one that delivers effective, efficient and equitable care.

As expected, the interaction of this dynamic group resulted in engaging discussions, extensive opportunities for input and feedback and finally, consensus on solid reform recommendations.

A Winnowing Process
Panels of thought leaders from across the nation brought their best ideas for health reform to the table. Discussions and an audience response system helped identify the ideas with the greatest level of support. Participants reduced the 18 best ideas to six in the final session, and these were ranked by importance and urgency.

Final Recommendations

1. Build public and business mandate for national change
2. Create transparency among systems and physician practices
3. Define essential health care services for all Americans
4. Develop results-based reimbursement, with a patient component to the incentive plan
5. Encourage formation of integrated systems
6. Reward consumers for choosing high-quality health plans and providers

Next Steps
Through the Mayo Clinic Health Policy Center, we will continue the mission of coalescing the many voices of health care reform into one collective voice and vision. A series of Policy Forums, comprising small workgroups of leaders, will hone the symposium's recommendations into concrete proposals.

The first forum will be held this fall. The ultimate goal is to recommend actionable solutions that can be discussed in the 2008 presidential debate and in the early days of the next administration.

Symposium Outcome

The consensus among symposium participants was strong in its directive for change in these three key areas:

1. Building a mandate for national health care reform
2. Health care that delivers value
3. Payment that reimburses for value

I. Building a Mandate for National Health Care Reform

Of the final recommendations, the one identified as most urgent and important is to build a public and business mandate for change. During the symposium, panelists and participants set out ideas for parameters on this mandate in numerous ways.

The symposium consensus:

The public expects major health care reform
Symposium participants believe the public expects — and needs — major changes in the health care system. Over the three days of the symposium, participants moved from being highly pessimistic to more optimistic that major reform at the national level is possible. However, participants believe federal policymakers are willing only to make incremental changes. A public and business mandate could embolden policymakers.

It is a moral imperative for all Americans to have health insurance
Symposium participants agreed that all Americans have a right to health insurance, which should be adopted through these actions:

• Universal coverage all at once, rather than incrementally expanding coverage through pre-planned stages or through groups
• Health insurance should be mandated, similar to how home and car insurance is mandated
• Health benefits should transition from employer-based to individual-based, with government subsidizing individuals who can not afford health insurance

The U.S. already spends more than enough on health care
Given that the United States currently spends 16 percent of GDP on health care, the consensus of the symposium was that health care reform does not require more money. What is needed, said panelists, is to use our existing resources more wisely: implement best practices, streamline processes, eliminate unnecessary care and reimburse based on value. "I believe if we simply apply things we already know ... and we did it excellently every day across the country ... we could have a huge improvement in outcomes from medical intervention and we could simultaneously reduce the cost of medical care 50 percent," said Monday keynote speaker Paul O'Neill, former U.S. Treasury Secretary.

II. Health Care That Delivers Value

Two of the final recommendations coalesced around health care that delivers value:

Transparency among systems and physician practices
This recommendation was based on discussions about the critical necessity for the medical community to share scientific knowledge and to practice evidence-based medicine. Central to this recommendation is the objective of improving quality and reducing medical errors. Transparency could give medical organizations the ability to be learning organizations, to constantly share successes and failures and learn from them.

Symposium participants, for the most part, rejected the idea of a central clearinghouse to disseminate medical knowledge. Rather, the consensus was to foster transparency with financial incentives, liability waivers and, most important, to have transparency not just for providers, but consumers, insurers, the news media and professional societies.

Encourage formation of integrated systems
The priority to encourage formation of integrated systems encompasses many of the ideas put forth during the symposium to improve the coordination of care, particularly care for patients with chronic illness.

Expert panelists offered numerous options for integrated systems and demonstrated how the integration adds value, including:

• Integrated systems can take various forms: an integrated medical group practice; an integrated network of independent physician practices; a hospital that integrates practices of its admitting physicians; or physicians networked by electronic medical record systems
• System integration should encourage sharing of medical knowledge and adoption of evidence-based medicine.
• Patients who receive care from multiple medical specialists have better health outcomes and lower medical costs when their care is provided by an integrated medical system
• Integrated systems are able to use systems engineering and business management practices to improve coordination of care for patients

III. Payment That Reimburses For Value

Symposium participants placed priority on three actions:

Results-based reimbursement, with a patient component for incentive
Panel discussions during the symposium focused on how reimbursement based on results would transform the health care system from one that serves acute episodic care to one that reimburses for coordinated care delivered over a period of time. Revised regulatory structures and payment systems would allow providers to shift from processes of primarily acute care delivery to results of patient health over the long term. Hospitals would evolve from revenue generated on a perprocedure basis to payment for coordinated, integrated care of patients.

Patients would have choices and could choose providers that deliver the best value, or results. This would create financial incentives for providers to deliver better results.

Reward consumers for choosing high-quality health plans and providers
Transparency for consumers is the critical component of this proposed reform for consumers, health plans and providers. The symposium panelists said we should strive to make information for consumers easy to access and understand, to help consumers choose health plans or providers.

Define essential health care services for all Americans
This final recommendation from the symposium reflects the symposium's emphasis on identifying those elements in health care delivery that offer the greatest proven value and eliminating coverage for those health care services that do not provide value and do not improve patient health.

Conclusion — Building a Mandate for Action

The symposium panelists and participants who invested their time, energy, ideas and inputs have created the beginning of an action plan and road map for substantive health care reform. The multifaceted approach will require a commitment to change from all sectors.

In choosing the need to build a public mandate as the most urgent and important need, symposium participants conveyed that the time for action is now. Mayo Clinic is committed to being an integral part of this effort to build a mandate for change. We hope that those of you who helped start this momentum will continue to help us drive change.