Collaborate, put patients first

By Tim Charles

The Institute for Healthcare Improvement recently invited representatives from 10 communities, including Cedar Rapids, to a unique forum in Washington to identify ways to transform health care - not simply to refinance the system.

All 10 participants were deemed to be in the top echelon of high-quality, cost-effective health care communities. Together, we identified common characteristics of communities providing world-class quality health care the most cost effectively.

These communities shared common characteristics: collaboration of providers, innovation, the presence of strong primary care networks, homogeneous communities and, most often, a non-profit culture that places patients' needs first. Not unlike Cedar Rapids, providers compete when it is of benefit to patients, and collaborate when in the best interests of the patient.

How does this inform us as to the direction health care reform should take? What do I urge Congress to do? Specifics that could and should be addressed include:

l Provide a safety net to ensure access to coverage while preserving choice.

l Reimburse for outcomes, rather than simply paying fees for services rendered.

l Eliminate discrimination of those with pre-existing conditions or chronic diseases.

l Expand coverage for the mentally ill.

l Provide incentives for a locally driven quality improvement collaborative and establish a real-time mechanism to share results and best practices nationally.

l Eliminate arbitrary geographic Medicare reimbursement disparities that have disadvantaged Iowa. The additional burden that Iowa's employers bear in offsetting the losses experienced by providers under the Medicare reimbursement program must be eliminated for the state to remain competitive. The magnitude of this disparity is such that in other parts of the country more is paid in per capita Medicare benefits than the average per capita income.

l Establish the capacity to share medical information to reduce duplication of clinical testing and to coordinate care.

l Actually transform the system. Consumers' increased access to their health care data enables them to accomplish the most important initiative of all: assumption of personal responsibility for individual health and well-being. Three-fourths of health care expenditures are the result of chronic disease management and much of this is because of lifestyle choices such as diet, smoking and exercise. Offer incentives for healthy decisions.

l Finally, communicating end-of-life decisions is an uncomfortable discussion. However, completing advanced directives and making wishes known is a responsible means of managing the emotional and financial burden we place upon our families and community.

The health care reform train has left the station with the speed of a bullet train. Unfortunately, the direction and destination are unclear and render a definition of reform next to impossible to deliver.

What is certain is that we are in for high drama, with Iowa's Sen. Chuck Grassley possibly holding the legislative trump card. The provider community in Cedar Rapids is also gaining stature as an exemplary model. In either case, we are poised to have a significant influence upon the future of the most important policy initiative of this administration.

Shaping the political agenda for change and recommitting to personal health and wellness are within our control. As Cedar Rapidians and Iowans, we can be confident that we have the opportunity to influence the outcome if our message is delivered and heard.

Tim Charles is president and CEO of Mercy Medical Center in Cedar Rapids.