The University of St. Thomas

Initiatives for Responding to Health Care Reform

Published on: Tuesday, July 24th, 2012

By Noi Oan, Full-time UST MBA class of 2013

On June 27, I was excited to leave work a little early to attend the “Initiatives for Responding to Health Care Reform” event at the University of St. Thomas. It was one day before hearing the decision from the Supreme Court regarding the future of the Affordable Care Act. Curiosity and anticipation of what going to happen next was the main driver for me to come to the event.

The panel included Jim Eppel, chief operating officer of Blue Cross Blue Shield of MN, Brian Rice, the vice president of Network and ACO Integration at Allina, and John Herman, the president of Fairview Northland Hospital and Maple Grove Medical Center. Dan McLaughlin, the director of the Center for Health and Medical Affairs, moderated the event.

Each panelist brought to the table a unique perspective about the current health care system and the necessary moves to a better future for their organization. However, one theme arose as the common ground for all panelists: the necessity of patient engagement to improve health quality and control total cost of care. Transparency of cost and quality is the essential vehicle to bring about patient engagement and it will be critical in the long-term solution, Jim Eppel emphasized. Brian Rice shared his excitement about testing and learning from patient data. By focusing on the 2-3% of the population that drove most of all health care costs, we can put more effort into engaging this population in a positive way. John Herman pointed to education as the key to patient engagement. Patients should know how to navigate the system and how to take responsibility to their own care. “Traditional episodic care treatment isn’t enough” he pressed.

In addition to hearing from the panelists, the event was designed as an interactive discussion, which fully engaged the audience. The panel shared their thoughts on three main issues before turning it over for audience discussion. The topics were chronic disease management, retail health and high deductible policies, and cost containment.

Chronic Disease Management

The audience discussed ideas to reduce hospital readmissions and ER visits by providing remote access through tele-health featuring Skype functions. They suggested that care education is important to engage patients in the care models and clarify any confusion from the system. More effort in data analysis will help better predict risk, readmissions, high cost and acuity.

The panel agreed with the audience. Brian Rice agreed with the need for more data analysis, suggesting that this effort could come from a patient advisory council or claims history from payers to see patient history. John Herman shared how Fairview is doing neighborhood health assessments to define needs and barriers of each community and, thus, better address their needs and involve community ownership. Jim Eppel pointed out that we are still trying to work backward from the previous insurance practice of absolving patients of responsibility. Instead, we need a direct incentive system to induce engagement, maintain longer term relationships and enter into a medical home relationship. Transparency is good, but not enough; we need to help patients understand their roles.

Retail Health and High Deductible Health Plans

In their discussion, participants suggested that a retail model will trigger consumers to ask these essential questions when shopping for their care options: Do I really need this procedure? This medication? Will generic work as well? Asking these questions would engage patients in a value discussion about their health plans.

Among the audience, high deductible health plans were generally seen as ineffective because consumers don’t necessarily know how to make these decisions. When the costs are masked, the choices are opaque. Home-based options, remote care and consultation will be helpful in educating and engaging consumers in their health planning.

High deductible health plans are driving consumer behavior to examine value and retail health is following. Health care now becomes a free enterprise, with access to technology and non-traditional care. The choices are more visible. The prices will continue to fall and chronic health management will be in front line. Furthermore, retail health has the infrastructure and easy outreach to community. However, they will need guidance and collaborative effort to understand and move through this stage of health care where mismanagement of cost was prevailing.

The panelists pointed out that the average consumer is often not prepared for truly high deductible plans. Health care became behavior driven. The panelists agreed that retail health would make more sense to consumers where it provides more access and more availability to most people. Their organizations are putting more effort in expanding that option. Another important point was how to capture information and share them between retail clinics to better care for patients. HIPAA requirements make it harder to release that information. Patients will need to understand the importance of carrying and sharing their health information for better care. Health insurance companies will need to work hard to turn claims data into helpful health information.

Cost Containment

The discussion on cost containment wove together with chronic disease management. Disease management will include data analytics to create a personalized approach and provide adequate support and mentorship. Many organizations have developed programs such as mentorship or a competitive approach to managing disease, peer support, or a health app where all information about the diseases, treatment and costs are available to patients.

The panelists agreed that consumer education is the key point and we need to get better at it. Transparency is still a challenge moving forward. While data is critical, we also need to understand how to use it, how to interpret it, how to determine quality/value, how to compare data across different choices. We need to be thorough with this.

There are five main points to take away from the discussion: how to turn data into useful information, ways to produce transparency, methods of reengineering, efforts in creating incentive to all system, and fostering true collaboration between organizations. The event was very successful and engaging with many lessons learned from the panelists and the audience. I think a forum discussion such as this one is a good tool to foster engagement and education. I would love to see and attend more of these, not only to better educate myself but also to get my opinion heard.

Noi Oan is a student in the Full-time UST MBA program, class of 2013.  She has three years of experience working in health care, mostly in clinical delivery. She is now pursuing an M.B.A. because of her interest in the business side of health care and desire to contribute more to health care decisions and management.

2 Responses to “Initiatives for Responding to Health Care Reform”

  1. Craig Ward, MHA, MLS (ASCP)cm says:

    Very nice summation of the presentation. I would like to correct one error that I recognized.

    This error is under the bold heading. “Retail Health and High Deductible Health Plans” paragraph 4 end of line 5.

    The word HIPPA is used. I think the correct acroymn is HIPAA; Health Insurance Portability & Accountability Act.

    Thank you for your attention to this correction.
    Craig Ward

  2. Erica Lyons says:

    Craig,
    You are correct – thanks for catching this typo! It’s been corrected.

    Thanks for the feedback!

    Erica