Tommy G. Thompson2013-05-24T00:48:43-04:00Tommy G. Thompsonhttp://www.huffingtonpost.com/author/index.php?author=tommy-g-thompsonCopyright 2008, HuffingtonPost.com, Inc.HuffingtonPost Blogger Feed for Tommy G. ThompsonGood old fashioned elbow grease.State Based Health Exchanges Are Importanttag:www.huffingtonpost.com,2011:/theblog//3.8855562011-06-27T18:44:06-04:002011-08-27T05:12:01-04:00Tommy G. Thompsonhttp://www.huffingtonpost.com/tommy-g-thompson/use free market principles and set up health insurance exchanges which work and give constituents freedom of choice. There is a lot of discussion about health insurance exchanges as it relates to President Obama's Affordable Care Act. Some governors have a negative opinion of insurance exchanges and I believe that by doing so they are giving up a tremendous opportunity to use marketplace choice and allow insurance companies to compete in their respective states. It would be a terrible mistake to have governors give up that opportunity to set up exchanges and forfeit that opportunity back to the federal government which would limit states' rights and their constituents' ability to pick and choose the best insurance for themselves and their families.
Just as governors did during welfare reform, by using these kinds of free market principles to chart a new course in dealing with welfare, they gave people hope for a job and independence and did not lock them into welfare dependency. Exchanges can be and should be a market-based solution. As a Republican and an advocate of market-placed innovation, I believe that health care should possess the same entrepreneurship zeal and leverage of technology that allows us to create an Apple iPhone or Amazon e-commerce portal.
Here's the most important thing that we must all understand about exchanges -- they are a market-place that can be implemented with a light touch. Exchanges are essentially an Internet portal with supporting customer service that provide individuals and small businesses with the ability to compare rates, benefits and quality across competing insurance options by allowing private insurers to offer such competitive plans in an open and transparent marketplace.
States must preserve their rights to operate the exchange: If states do not build an exchange, the Affordable Care Act requires that the Federal government step in and run the exchange. This is a great opportunity for states to be a laboratory of innovation. Whoever controls the exchange also controls access to and entry into the state Medicaid program. If you give control of the exchange to the Federal government, you also give them control of the Federal Medicaid grant program. Do we really need to provide the Federal government day-to-day control into the largest liability items on the state budget?
Court action is unlikely to torpedo the exchange. Several lawsuits have questioned the legality of health care reform and in particular the mandate to buy health insurance, but the Exchange itself is not the focal point of such litigation. The Supreme Court's anticipated ruling on the individual mandate is thus unlikely to abolish the exchange unless the Court strikes down the law in its entirety. Any narrow ruling against the mandate itself will not preclude the rest of the health care reform law, including the exchange directive, from being enforced by the federal government.
An exchange does not need to create a new bureaucracy. Many of the opponents to the Affordable Care Act are concerned about creating yet another state bureaucracy. They are right about this concern -- but this concern can be addressed if states plan wisely. Many states across the country today operate health insurance programs of "last resort" for at-risk citizens, and such programs are essentially out-sourced. I believe that this is the right model for exchanges -- states can simply organize the private market, and specify how an exchange ought to operate to create transparency and audit them, but do not actually need to run them.
Exchanges are a market-place, let us make them a state market-place. Exchanges are a vehicle for future innovation in health care delivery -- and if there is one thing we know we all need here, it is a platform for better ideas. States that take charge of the exchange will be in the driver's seat; those that don't will take a back-seat to the federal government.
]]>Medicare Debate Can't Only Be About Cutstag:www.huffingtonpost.com,2011:/theblog//3.8575042011-05-04T15:22:22-04:002011-07-04T05:12:01-04:00Tommy G. Thompsonhttp://www.huffingtonpost.com/tommy-g-thompson/Two weeks ago, Gov. Thompson wrote an opinion piece on reforming Medicare incentives and suggested a capitated environment as a potential solution. In this piece, Gov. Thompson joined with Don Crane, president and CEO of the California Association of Physicians Group (CAPG) in discussing California's experience with a capitated environment.
Medicare spending is growing at an unsustainable rate of 7.9 percent and will soon reach 17 percent of all federal spending. In order to bring it under control, the Medicare system should be reformed to realign the financial incentives of doctors and other health providers. Specifically, the system should be reformed from the current "do more procedures, make more money" fee-for-service model, to a system where physicians are financially incentivized to provide the highest quality care to patients.
Despite this broadly recognized need to shift the way the federal government pays for health care, the debate up to this point has focused on the wrong tools needed to reform Medicare. Rather than discussing the need to change financial incentives for physicians and hospitals, the focus has been on concepts like the Independent Payment Advisory Board (IPAB), which cut Medicare spending without making any changes to the underlying systemic problems. The board represents a new federal bureaucracy that can propose binding cuts to Medicare. Only a Congressional supermajority can overrule the IPAB's recommendations.
However, instead of these broad cuts, lawmakers should get to the root of the problem and fix the underlying payment system.
One model for fixing this problem is already at work -- proving results in terms of improving quality for patients and reducing costs for payers. In California, medical groups and independent practice associations (IPAs) have been paid on a capitated basis by Medicare and some private payers. In a capitated setting, a set amount is paid for each patient's care, regardless of the number of procedures done. Rather than creating an incentive to do more, the physician has an incentive to create a patient-centered, coordinated care model.
The coordinated, integrated care these groups and IPAs perform has paid dividends in terms of cost savings and quality for patients. For example, in 2008, when physicians from CareMore, an IPA serving 43,000 patients based in Cerritos, heard news reports that a heat wave was going to hit southern California, the physicians began contacting their low-income emphysema patients. The physicians were concerned that without air conditioners, these patients would likely end up in the emergency room. For the patients that indicated they had no air conditioning access in their homes, the physicians went out and purchased and installed air conditioners in the patients' homes. The resulting cost of the air conditioners, about $500, paled in comparison to the cost of an emergency room admission-but perhaps more importantly, the physicians' actions kept these patients out of the hospital. The payment model that CareMore and other California physician organizations operate under allow these types of innovative approaches to improving patient care.
The models that allow this type of practice include the Integrated Health Association's pay for performance program. Participants include eight health plans and over 225 physician organizations, representing 35,000 physicians that provide care for 10.5 million Californians. The IHA evaluates physician groups using a survey that examines doctor-patient communication, care coordination, timeliness of care, and overall care experience and provides financial incentives for well-performing providers on each of these metrics. Results from the program have showed steady improvement on the measures since the introduction of the program in 2003.
Innovative approaches to prevention, wellness, and keeping patients out of the hospital, have helped California's physician groups and IPAs make great strides in terms of controlling the cost of care. In California, Medicare patients who were enrolled in a plan using a capitated payment methodology had hospital utilization rates of 982.2 hospital days per 1,000 as compared to Medicare fee-for-service patients with 1,664 hospital days per 1,000. Looking at the costs associated with these utilization rates, in Kern County, for example, the estimated savings were as high as $800,000 per year, if fee-for-service beneficiaries were seen by coordinated groups.
We believe that the success of California's medical groups and IPAs can spread across the country. For example, on March 31, 2011, Medicare released regulations creating accountable care organizations, which are designed to promote integrated, coordinated care. A properly structured ACO could embrace the quality, efficiency and patient-centered standards that California's medical groups, IPAs, and payers have already achieved. The success of this model requires attention to the available payment models, the quality metrics, and other key aspects of the program to ensure that we are truly changing the delivery system and not just repackaging the flawed, existing system.
Honorable Tommy G. Thompson, Akin Gump Strauss Hauer and Feld
Donald H. Crane, President and CEO California Association of Physician Groups (CAPG)
]]>Reform Medicare, Don't Cut Ittag:www.huffingtonpost.com,2011:/theblog//3.8510382011-04-19T12:28:05-04:002011-06-19T05:12:01-04:00Tommy G. Thompsonhttp://www.huffingtonpost.com/tommy-g-thompson/
Domestically, the primary challenge we face is entitlement spending (above all, Medicare). While non-defense, non-homeland security discretionary spending is 16 percent of the budget, Medicare represents 15 percent. And, Medicare is growing. It is predicted to reach 17 percent of federal budget outlays and four percent of the gross domestic product by 2020.
While there was significant discussion of "bending the cost curve" during the health reform debate, the truth is that little was done that would impact overall growth of federal health care spending. The law contains Medicare cuts, but the savings achieved are then used to pay for new federal spending, such as the Medicaid expansion and new subsidies to purchase health care in state-based exchanges.
When a federal program is growing, the easiest path forward is to continue to cut it. But the problem with Medicare is that it is so complex that if you cut growth in one area, costs are simply shifted to other areas. What ensues is a sophisticated and high stakes game of "whack-a-mole." This is exactly what health reform did through the creation of the Independent Payment Advisory Board, or IPAB.
IPAB is an unelected board that can propose binding cuts to Medicare. These cuts can only be overridden by a Congressional supermajority vote. The IPAB's mission is to meet government standards of cost-cutting, with little to no regard for the impact on the consumer or health care providers. Instead of placing the decision in the hands of unelected bureaucrats, let's put it back where it belongs -- in the hands of doctors and patients.
As someone who knows firsthand the intricacies our nation's health care system, the far better approach is to realign existing incentives. Stated simply, the fee-for-service system is fundamentally flawed -- it rewards providers for the volume of services they provide rather than rewarding them for providing the best care to the patient. The more procedures performed, the more a doctor gets paid. Further, our third-party payer system removes patients from having a financial stake in their health care decisions. We need to shift the incentives to build a system that focuses on providing high quality, low cost care that focuses on the patient.
The good news is that we don't have to wait to begin to realign physician incentives. The Affordable Care Act gives great discretion to the CMS Administrator to experiment with alternative payment systems. CMS has created an "innovation center" and is looking for ideas. I believe the administration should use its discretion to begin to experiment with capitated payment, where one fee is paid for a patient episode of care, regardless of how many procedures are performed. This gives the physician a financial incentive to improve quality by performing the right procedure the first time. Under a capitated system, the government is not on the hook to pay for unneeded procedures.
In addition to properly aligning the physician's incentives, we need to align the patient's incentives. House Budget Chairman Paul Ryan (R-WI) is leading an important conversation about how to develop a system that would encourage consumers to put some skin in the game. Ideas that give financial incentive for patients to get more involved in their care and making them more responsible for their health care choices are an important part of the dialogue that must take place if we are ever going to truly bend the cost curve.
Regardless of party, it's time to adopt a constructive approach to federal spending. To that end, let's work to shift Medicare to a system that incentivizes the right care, every time, and helps patients be more responsible for their consumption of health care services. Simply cutting Medicare isn't the answer by any means. Instead, let's focus on the most effective fiscal path forward with the least amount of impact on millions of seniors, their families and our broader economy.
In other words, reform Medicare, don't cut it.]]>Health Diplomacy Is Critical to U.S. Foreign Policytag:www.huffingtonpost.com,2011:/theblog//3.8233822011-02-15T10:32:57-05:002011-05-25T18:30:24-04:00Tommy G. Thompsonhttp://www.huffingtonpost.com/tommy-g-thompson/
Health diplomacy means winning the hearts and minds of those abroad by strategically exporting medical care and humanitarian aid, building in-country capacity, and providing health education, training and personnel. Health diplomacy encompasses a range of services, such as delivering life-saving AIDS medications in remote African and Caribbean villages; delivering emergency health care, medications and medical supplies in Haiti, Indonesia and Pakistan following devastating natural disasters; providing polio vaccinations for children in India; partnering with medical researchers in Ireland and Brazil; and working with influenza epidemiologists in China.
During my tenure as the Secretary of U.S. Health and Human Services, I witnessed first-hand how health diplomacy works. Perhaps the most powerful example of health diplomacy is the President's Emergency Fund for AIDS Relief (PEPFAR). Created in 2003, PEPFAR remains the largest health initiative by any one nation to combat a single disease. The enormously successful program is a model for health and foreign assistance because it incorporates these fundamental elements: accountability, measurable goals, public-private partnerships, and in-country ownership to deliver services.
Health diplomacy recognizes that the health and security of our own citizens is tied directly to that of our neighbors around the world. Through the bond of health care, this strategy builds strong, lasting relationships -- relationships that secure our nation's future and build a strong, stable global community.
The link between political unrest and poor health is well established. Studies show that nations with the highest mortality rates for infants and children under age five are those most likely to engage in war. Terrorist groups use this link to their advantage by targeting the health care infrastructure as a means to delegitimize governments. Some terrorist groups also provide health care services to local communities, thus earning the support and loyalty of the population.
Research also clearly links health and the economy. Ill children don't receive the education they need to contribute to a strong future economy. Sick adults can't work and cannot care for their children. Crops aren't grown, goods aren't produced, families and communities break down.
The connection between health, security and economic success has gained traction among global health policy stakeholders. I urge the 112th Congress to build on this momentum. Health diplomacy must be institutionalized as a critical component of U.S. diplomatic, defense and foreign policy. Global health is not a Republican issue or a Democrat issue. It's not even exclusively an American issue. It is the moral responsibility and strategic concern of every freedom-loving citizen of the world. ]]>A Business Lesson for Health Care Reformtag:www.huffingtonpost.com,2009:/theblog//3.3196392009-10-13T19:02:57-04:002011-05-25T14:20:22-04:00Tommy G. Thompsonhttp://www.huffingtonpost.com/tommy-g-thompson/
As our nation's population ages, staggering increases in the cost of providing health care threatens to bust budgets from Main Street to Wall Street, killing jobs and sapping the strength of our economy. Far too many hard working families are priced out of the health insurance market and driven into bankruptcy. Businesses' health costs, in particular, are skyrocketing, meaning impaired bottom lines and depressed wages for workers.
Among the biggest cost-drivers in health care today is treating chronic illness, including heart disease, cancer and diabetes. The Centers for Disease Control reports that: chronic disease treatment accounts for 75 percent of all health care spending in America and 99 percent of Medicare spending. More than half of Medicare beneficiaries are treated for five or more chronic conditions annually. And yet patients who suffer from these conditions still aren't receiving all the treatments that are recommended. A RAND study found that patients typically receive only half of the clinically recommended treatments for their chronic disease conditions.
We can do better. We can no longer afford not to.
The closest thing to a silver bullet to improving efficiency in health care delivery is to focus on disease prevention and management. This requires incentives to control risk factors like smoking and lack of exercise, and to support a more holistic notion of health care delivery. Rather than waiting for people to get sick before paying for their health care, we need to make more up-front expenditures to prevent down-the-line costs.
For example, IBM sponsors an innovative employee wellness program that relies on incentives and care coordination to improve the health of its workforce. Their employees are given access to at least one health plan at no cost. This plan includes coverage for preventive service, as well as a "Healthy Living Rebate" that gives $300 to employees for participating in healthy activities. A Children's Health Rebate program gives IBM families similar incentives.
The result? Between 2004 and 2007, the reduction in employee health risks alone resulted in an estimated health cost savings of $79 million. Meanwhile, employees benefit from improved access to health care leading to more productive and healthier lives.
There are other good examples of the value of prevention and care coordination in catching problems early and thereby helping to reduce long-term costs.
For instance, many states employ a comprehensive care model to cover Medicaid patients. Vermont, North Carolina, Colorado, Pennsylvania, and other states fund Community Health Teams (CHTs), which work with patients to improve their overall health and reduce costly trips to the hospital. Members of a CHT serve as advisers on healthy living and work hand-in-hand with a patient's doctors and hospital to coordinate care. Vermont has seen amazing results with a 30% decrease in emergency room visits in the first year of the program.
The federal health reform legislation winding through Congress offers a big opportunity to lower our nation's health costs by expanding the use of CHTs. Most Medicare patients receive health care through a fee-for-service model, which provides payments to doctors and hospitals based on the number and type of services they provide. If a patient comes back six times for the same problem, the doctor or hospital gets paid six times.
Medicare offers no incentives to prevent over-use of health care services or to coordinate care among a patient's doctors and hospital. Medicare pays for people who are sick, but doesn't do much to keep them healthy.
Community health teams will make the primary care provider the patient's essential quarterback in coordinating delivery of quality care. An abundance of evidence shows that the kind of care coordination that physician-managed community health teams provide for patients improves their health outcomes, while reducing health costs over the long run.
According to a recent survey commissioned by America's Agenda: Health Care for All, 75 percent of voters support reform that will give their primary care or family doctor the support of a coordinated team. We should amend the bill in the Senate to move Medicare in this direction, provide increased support for CHTs and encourage businesses to offer more wellness and prevention services.
Whether it is the amount we pay in premiums or the total contribution made by employer to the company health plan, America must begin to focus this debate where it belongs: on the bottom line. American taxpayers, from consumers to large businesses, cannot and should not be forced to shoulder the burden of a failed system that only accelerates cost and benefits a handful of insurance companies and investment bankers.
It's time for Congress to enact a reform package that provides all Americans with quality, affordable health care for years to come. ]]>What Needs to Be Donetag:www.huffingtonpost.com,2009:/theblog//3.2796682009-09-08T14:50:53-04:002011-05-25T14:00:22-04:00Tommy G. Thompsonhttp://www.huffingtonpost.com/tommy-g-thompson/
While the summer has been all about the sensational, the scandalous and the ideological, the fall must be a time of substance, centrality and pragmatism. Recognizing the political challenges of passing a comprehensive bill by December, he must seize on those consensus issues that -- in survey after survey, and statement after statement -- the vast majority of Americans say they want their government to do something about.
And he must clearly communicate to Americans how measures in current bills will address their concerns and improve upon what they have today.
In particular, he needs to reach out to the 85 percent of Americans with health insurance coverage and remind them about the risks of maintaining the status quo. Health care costs are growing so quickly that we must make changes to stem the growth -- otherwise, neither as individuals or a nation, insured or uninsured, will we be able to cover our health care bills.
The question is what policies under consideration do the vast majority of Americans view as being "worth" the investment -- not just tomorrow, but today.
The answer that tops the list is prevention. Americans are literally sick of a health care system that doesn't improve health, but instead waits until we get sick before it springs into action. That's why policies that will reorient our system to emphasize prevention is an idea that ranks at the top of what Americans want in health reform -- well above ideas that get a lot more attention from politicians and the media. In fact, according to a recent Trust for America's Health survey, Americans rated prevention as the top priority in health reform, above providing tax credits to small businesses and prohibiting health insurers from denying coverage based on health status.
In this highly politicized debate, it's important to note that a vast majority (88%) of voters -- Republicans and Democrats alike -- favor such an approach to reform, according to a recent survey by bipartisan pollsters Celinda Lake and Bill McInturff. For instance, there is strong bipartisan support for policies that make it easier for Americans with chronic disease to appropriately manage their conditions and prevent complications -- such as eliminating co-pays and deductibles for treatments for chronic illness -- which are a part of current reform proposals.
Policies to improve coordination of care, and prevent complications from illness and hospitalizations, also enjoy bipartisan support.
In Medicare, where -- quite literally -- all (99%) of our spending is linked to patients with chronic illness, there is ample opportunity to make a dent in cost, and improve the health of beneficiaries, by enacting changes to reduce complications and limit hospital readmissions. Up to 20 percent of Medicare hospital admissions result in readmissions within 30 days at an annual cost of $15 billion, of which $12 billion is potentially avoidable. And this is not rationing -- these are admissions and readmissions to hospitals that could have been prevented in the first place through well-managed and coordinated plans such as those at Gunderson Lutheran Health system in La Crosse, Wisconsin and the Mayo Clinic in Rochester, Minnesota.
Americans also want policies that increase support for coordination of care outside the hospital, and that strengthen the primary care network. Three-quarters of voters support better coordination of treatment by establishing personal medical teams of health professionals coordinated by a family doctor.
To further improve coordination and continuity of care, Americans favor enhancing the availability of patients and providers to access "real time" information. Nearly three-quarters (73%) support the development of a national health information technology network of electronic medical records. Not only would this reduce common medical errors that lead to additional illness and in some cases death and drive up costs, it would eliminate our reliance on our current paper-based system that leads to inefficient, fragmented care and produces waste.
Such common sense reforms will go a long way toward fixing the problems that Americans see every day in our health care system. This, of course, leads to the ultimate goal of what we need our health care system to deliver: better health, an improved quality of life and more affordable care.
President Obama certainly faces an uphill battle along the road to health reform. But as long as he advocates for those things that Americans, from all sides of the debate, believe are worth investing in, he will find he has a lot of company along the way.]]>