Cost of doing nothing is great

By The Gazette Editorial Board

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As the baby boomer generation moves into retirement over the next 19 years, the number of Americans eligible for Medicare will swell to 77 million - 32 million more than the current number.

Many health care officials and government experts predict that the current system simply will be overwhelmed. Not affordable. Something has to change to better control costs and still maintain care.

Agreed. Containing health care costs, which have increased much faster than most other sectors of the economy, is still a moving target nearly one year after Congress signed major reform legislation into law. Iowa providers do better than the national average but our state certainly isn't immune to the problem.

Bill Leaver, president/CEO of Iowa Health System, Iowa's largest integrated health organization, believes parts of the reform law beyond the dicey issues of access and insurance mandates provide opportunity to address the cost issue and also provide improved care.

Specifically, it involves the coordinated-care concept: A medical home for each patient. Primary care providers, specialists, hospitals and other providers - even from competing organizations - operating as a team to share information and provide a continuum of care for their patients. Expanded use of electronic data technology. Payments based on patient outcomes and shared by the team, instead of the traditional fee-for-service model, which is based on the volume of patients and treatments and tests ordered.

Leaver and others believe that coordinated-care, or accountable-care, organizations can better manage patients' health care and reduce costs, especially when it involves recurrent, long-term problems. Patients with one or more chronic diseases or conditions account for 50 percent of costs but only

5 percent of the population.

Coordinated-care proponents say patients will engage their providers more often, learn how to manage their health problems and cut down on trips to hospitals and emergency rooms. Doctors and patients will have more say in care choices, insurance companies less.

But will it work?

Our questions include: Can the coordinated-care model persuade most patients to change unhealthy lifestyle behaviors? Will doctors in a coordinated-care group be able to opt out of caring for patients who don't follow their care recommendations? Will more or fewer patients be served effectively? Will many competing providers agree to participate? And will the “global” payment structure satisfy doctors and still reduce costs?

Iowa Health System is pursuing pilot projects in Fort Dodge and Des Moines to test such an accountable-care organization. There are some state regulatory and antitrust restrictions, as well as resistance from some insurers, to overcome.

Despite our reservations, we hope state legislators can work through the barriers and give the pilot projects an opportunity to prove their worth. Not every new approach to health care delivery will control costs while providing good service.

But not trying will only further delay finding solutions.

n Page 11A: Leaver's guest column

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