Wednesday, April 15, 2009

News From the World Health Care Congress

In the opening day of the World Health Care Congress, the Disease Management Care Blog didn’t really hear anything new, but there were a few interesting and random wrinkles. It seemed like everyone is simply repeating themselves, apparently hoping that by saying the same thing over and over, the Congress and the Administration include will include them the design of the upcoming health reform package.

Here are some of the wrinkles that caught the DMCB eye:

The gracious Dr. Dora Hughes laid out the principles that the Obama Administration will be seeking while it works with Congress to craft mutually acceptable healthcare reform legislation. Those principles are protecting families, promoting affordability, including prevention, increasing quality, having more portability, preserving provider choice, ending the use of preexisting conditions to deny coverage and reducing the upward cost trend. All well and good, but Dr. Hughes spoke in careful generalities, giving the impression that she had been carefully coached. She remained very loyal to parroting the administration line. The DMCB has witnessed this with speakers from the last administration. Plus la change…..

How about the controversy of a federally supported public plan? Dr. Hughes said the Administration didn’t care if the principles above remain intact. Bruce Bodaken of Blue Shield of California didn’t surprise anyone when he argued that the right kind of regulatory oversight of the private market could readily lead to access, fairness, universality and affordability without the downside of government intrusion. But it was John Kingsdale of Massachusetts‘ Commonwealth Health Insurance Connector that pointed to a middle way. His State does not use a classically defined public plan. Rather, he noted they rely on government subsidized Medicaid managed care organizations with Medicare-style fee schedules that act like a public plan. The point: if Republicans and Democrats change the definition of a public plan and blur the distinction between private and public options, they may be able to find a (insurer of last resort on steroids?) compromise that keeps everyone happy.

Mr. Kingsdale made some other interesting points about cost control, which can be paraphrased as follows: The road to cost control goes through health insurance reform. Access to health insurance is the moral high ground that can next be protected by controlling health care costs. The country can’t let cost control hold the uninsured hostage. While the DMCB isn't sure it agrees with the logic, the man has a point.

Mr. Kingsdale also pointed out Massachusetts isn’t necessarily a model for national health care reform because 1) since health insurance and health care are really local, States rely on a level of ‘intimacy’ in creating consensus over things like benefit packages and networks. It takes a lot of work and even when there is agreement, the work has only just begun. Maintaining consensus and building on the initial success takes time – which is unlikely in Washington DC. A speaker from Minnesota echoed the same refrain. Both hope that Federal health reform gives the States breathing room. The DMCB finds it ironic that these liberals are arguing on behalf of States' rights.

New Gingrich weighed in briefly on health information technology by pointing out that the biggest danger is creating a system that not only will be obsolete but locked in and therefore too big to change. As you may suspect, he distrusts large government solutions.

Practically everyone - and the DMCB means EVERYONE - repeated over and over how important care management is. All population-based programs, including disease management, were included. If you work in that industry, the future seems bright indeed.

Over the next two days, the DMCB will continue to scour the WHCC for more nuggets.

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