Mayo Clinic National Symposium on Health Care Reform

Tuesday Session, May 23

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

Solutions to Deliver the Best Value in Health Care

Panel experts and symposium participants worked to identify solutions that would deliver the best value in health care during two sessions on Tuesday:

• Paying for high-quality health care


Enlarge

• Building a better chronic care model

Participants indicated that spending for health care is not the problem. A majority of participants felt the United States spends too much on health care already. More than 85 percent of participants also said that consumers shouldn't be expected to pay more for quality care. What we should be striving for is better value.

Two common themes from both sessions were

• Organizing health systems to deliver high-quality care
• Reforming reimbursement to reward providers who deliver the best outcomes for patients

Organizing Health Systems to Deliver High-Quality Care

Physicians are most effective and efficient when they are engaged with or integrated into health care systems, whether they are in group practices or solo practitioners. Elliot Fisher, M.D., M.P.H., who has studied variation in health care delivery, said, "if everyone performed as well as Mayo or Intermountain Healthcare (two integrated systems), we could lower costs by about 30 percent."

Bruce Bradley, Dr. Denis Cortese and Donna Lynne, part of the "Bottom Line" panel

He added that practitioners don't need to be consolidated in one health organization. A common medical record system can link independent practitioners and help them work more collaboratively.

Bruce Bradley said his business strongly supports the need for better organized care. "In my opinion, every physician in the country ought to be affiliated with an organized delivery system," he said.

Chronic care panelists pointed out the difficulty of interacting with a health care system designed for acute care. "The system is designed to treat complications rather than prevent complications," said John McDonald, M.D., Ph.D.

In a chronic care model, Colleen Conway-Welsh, Ph.D., R.N., said health care would be most effective if it fully leveraged the capabilities of nurses, nurse practitioners and allied health professionals, along with physicians. "We need to look at the right provider at right time to do the right thing," she said.

Reimbursing to Reward High-Quality Outcomes

Donna Lynne, Dr.PH., of Kaiser Permanente, said a key challenge is to clearly define quality, given that consumers want more than just clinical outcomes in their care. They also want to feel satisfied with their providers.

Denis Cortese, M.D., of Mayo Clinic, said providers need to be able to practice not just the science, but the art, of medicine. "We spend time with patients. We aren't paid for that. You can't give a patient an hour of time in 15 minutes."

Employees at General Motors are educated about and encouraged with financial incentives to use high-quality care providers, said Bruce Bradley. GM has a sophisticated system for measuring quality. However, Bradley added, GM still needs to be more sophisticated about measuring the cost and overall value of providers.

Establishing Priorities

Effectiveness

Efficiency

Equity

Enlarge

Symposium participants divided into three groups to discuss nine action items identified in earlier sessions. By electronic voting, they narrowed the items to six.

The 18 action items were presented to the full symposium and then, again by electronic voting, the list was narrowed to a final list of six action items.

Final Recommendations

In order of importance and urgency

• Build public and business mandate for national change
• Transparency among systems and physician practices
• Define essential health care services for all Americans
• Results-based reimbursement, with patient component to incentive plan
• Encourage formation of integrated systems
• Reward consumers for choosing high quality health plans and providers

Participants then rated these priorities in terms of importance and urgency for action.

Looking at the priorities, Hugh Smith, M.D., symposium co-chair, said, "There's no single bullet — it's a multifaceted issue that will require a multifaceted approach."

At the end, participants were presented the same set of questions they answered at the beginning of the conference. Dr. Smith noted that the conference had an antidepressant effect, as results showed a noticeable shift toward a more optimistic attitude about health care reform among participants. See summary slides. (PDF)

Next Steps

Dr. Smith and symposium co-chair Pat Mitchell stressed Mayo's determination to keep working hard on these issues. The symposium priorities will be forwarded to the Mayo Clinic Health Policy Center, to be further refined in a series of Policy Forums.