Mayo Clinic National Symposium on Health Care Reform

Monday Session, May 22

Monday Summary (PDF)
Slides from Monday session (PDF)
Webcast (archived), suggested readings and video clips

Summary

Paul O'Neill, former U.S. Treasury Secretary, spoke about the effects of strong leadership.

Tackling problems of ineffectiveness and inefficiency in the health care system requires strong leadership and a commitment to transparency, according to presentations and symposium participant input during Monday sessions at the Mayo Clinic National Symposium on Health Care Reform.

Paul O'Neill, former U.S. Treasury Secretary, told the luncheon crowd about how leadership can set an organization's culture and expectations to reduce medical errors.

One step toward reducing medical errors, he said, is to require physicians to write their prescriptions legibly.

John Wennberg, M.D., M.P.H., pointed out how lack of transparency and lack of leadership has led to great variations in how patients receive medical care.

Providers need to work together to manage their patients, said Hugh Smith, MD. "Physicians have to put their ego aside in the interest of the patient. If you're uncertain, you have to find someone somewhere who knows more."

Steve Case expressed optimism about consumer trends for greater use of Internet tools which would foster greater transparency. When it comes to health care, Case said, "It seems to me we need to blur the lines [between sickness and health] so that it's more of a process and you're on a spectrum of care, with interactive online contacts with a physician."

Consensus for Individual-Based Insurance

Expert panelists for the session on the uninsured

Health reform is on a path to replace employer-based insurance with individual-based benefits, according to a panel of five health policy experts at Monday's session on the uninsured and underinsured. Symposium participants reflected that view during electronic voting.

Panelist Stuart Butler, Ph.D., said individuals need more options than employer-based insurance, including new tax incentives. "We give enormous tax benefits to people who have insurance through their employer, and none to those who don't."

Two of the experts, Ezekiel J. Emanuel, M.D., Ph.D., and Victor Fuchs, Ph.D., have proposed an alternative: vouchers for individuals to obtain health coverage, along with new controls to contain cost. The vouchers could purchase essential benefits and individuals would have the option to buy extra coverage.

Essential Benefits
Butler said the public needs to decide what would be an acceptable level of benefits that a voucher would cover.

Louis Sullivan, M.D., suggested decisions for health care reform need to emphasize more prevention efforts.

Lack of a Public Mandate
While the experts came to a consensus about employer-based insurance, Fuchs noted that the public has not come to any consensus about the need for health care reform.

"Up until now, despite what the polls say, there hasn't been strong, persistent support on the part of the American people for change. If there were opposition by organized economic interests, that would be overcome. They are not the main problem. The problem is us," Fuchs said.

Info at the Right Place & Right Time

Sanjay Gupta, CNN, Leads a discussion

At the Reducing Costs panel on Monday, panelists spoke about the need for medical practices to replace their disjointed operating systems with work flow processes and business management systems.

Making the leap from information into applied knowledge can be challenging, said Sanjay Gupta, M.D., CNN health reporter and moderator. Physicians, patients and their families, and consumers can all benefit from having better information, if they know how to interpret it.

Hugh Smith, M.D., said everyone along the line in health care, from patient to family to physician, needs incentives to take care of themselves.

Carolyn Clancy, M.D., anticipates that physician quality measures will become more common, including for individual physicians.

Gary Kaplan, M.D., suggested Toyota as a management model. Eugene Litvak, Ph.D., explained the critical need to coordinate hospital admissions.

John Wennberg, M.D., M.P.H., commented on hospital construction: "How that capacity gets organized around a community is interesting, but it has nothing to do with illness."

An efficient health system, said Roger Feldman, Ph.D., requires competition in the choice of health plans and health providers. He noted that consumer-driven health plans are having an effect in making consumers choose more wisely.

Business Roundtable

Linda Dillman from Wal-Mart makes a point at the Business Roundtable. Moderator Pat Mitchell is at left and Harriet Pearson from IBM at right.

Employee cash incentives and discounts on fruit and vegetable purchases are some of the approaches used by four international businesses to reduce their health care costs. Among the other insights offered at Monday night's business roundtable:

Carlson Companies
Carlson Companies works with other employers to contract directly with health care providers to manage costs. As part of the Bridges to Excellence program, the company rewards physicians who treat patients according to defined protocols.

Wal-Mart
Wal-Mart's benefit costs for its over 1 million employees consume nearly 50 percent of annual profit, said Linda Dillman, executive vice president. Wal-Mart has scorecard systems to track its suppliers' performances, so why can't health care have scorecards, Dillman asked.

Sun Microsystems
Sun Microsystems CEO Scott McNealy wondered why health care does not use existing technology. "It's ludicrous we're not utilizing these capabilities in the health care arena."

Individuals need to accept responsibility for the choices and decisions that affect their health. "It's not Wal-Mart's job to make sure you don't eat pizza every night," McNealy said. "It's your life — it's your responsibility."

IBM
IBM employees have access to primary care physicians at zero cost, said Harriet Pearson, chief privacy officer. Aggressive disease management strategies have delivered significant cost savings for the company. IBM is developing personal health care records and offers cash incentives to employees who participate in wellness programs. The company is also among a group of large, influential employers looking to create processes to protect health information.