Industry outlook: healthcare.

Position:Panel Discussion
 
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Insurance issues took center stage at the Utah Business healthcare roundtable. Many participants agreed much needs to be done to remedy the medical insurance problem around the nation and in Utah. The industry is also concerned about the effects of a growing and aging population, new hospital construction and the escalating emergence of niche clinics across the state.

Participants at this year's healthcare roundtable included: Joe Krella, Utah Hospital Assoc.; Suzette Green-Wright, Health Insurance; Todd Wecker, SHC Services; Maureen Keefe, Dean of Nursing, U. of U; Greg Poulsen, IHC; Michael Bahr, Altius Health; Richard Sperry, VP, U of U; Wayne Imbrescia, Moran Eye Center; Scott Williams, Ex, Director, Utah Dept. of Health; Richard Dahlkemper, Assoc. Professor, Weber State; Mikelle Moore, LDS Hospital; Don Murray, United Health; Rich Fullmer, U. of U. Hopitals & Clinics; Brent Williams, Dental Select.

Special thanks to Dr. Stewart Barlow, president of Utah Hospital Association (UHA), who was our moderator this month. Thanks to Westminster College for providing the location.

HOW DO WE BALANCE THE INTERESTS OF PATIENTS, DOCTORS, AND/OR SERVICE PROVIDERS AND INSURANCE PROVIDERS? WHAT ARE THE AREAS OF CONFLUENCE AMONG THESE GROUPS, AND WHAT ARE THE AREAS OF COMPETITION AND SHOULD WE ADDRESS THOSE?

POULSEN: For me, the easiest part is to address what the areas of common interests and conflicts should be. Providing the best demonstrated care is clearly an area of confluence, and I suspect there aren't any of us around the table who view trying to balance the interest of patients with the other two. There may be some balancing between physicians and insurance organizations and hospitals and insurance organizations. I think all of us would put the patients' interests ahead of the others, clearly.

We are finding increasingly that there are best ways to provide services and care, and that by focusing on those we end up providing a higher quality outcome at a, generally speaking, lower cost, which serves all three interests well.

YOU ARE REFERRING TO BEST PRACTICE MODALITIES. CAN YOU REFRESH EVERYBODY'S IDEAS ON THAT, AND PERHAPS GIVE US SOME SPECIFICS THAT YOU CAN POINT TO WHERE ONE SAVED MONEY BUT ALSO PROVIDED A NEW STANDARD OF CARE?

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POULSEN: I wouldn't view it as being a new standard of care so much as applying something most clinicians recognize as being the best practice, but doing it consistently every time.

An example would be inducing a delivery prior to 39 weeks of gestational age. And what the literature has said for some time is that the likelihood of having a sick baby from that process increases the earlier you go before 39 weeks. We looked at our data and found that that was true.

THAT'S A GREAT EXAMPLE. THEY RECEIVED SOME NATIONAL ATTENTION, AND I THINK THAT INITIATIVE WAS STARTED HERE IN UTAH.

S. WILLIAMS: The challenge when you impose a market competition model on healthcare is whether that really serves quality. An example would be: It's going to cost the hospital more to prevent wrong-side surgery or prevent medical errors. The hospitals that invest in that are going to be doing the right thing for the patients, but a hospital may be able to not do that and get away with it for a while because those are not that common an event, maybe. And then they are competing on price and sacrificing quality.

Another example would be the controlling of a patient's health or medical information. You find me in one system and I show up in another system, it's in my best interest to have my information rapidly available to the doctor in that other system, but in order for that to happen, we have be able to cooperate like the financial industry cooperates so that my credit card information can rapidly be accessed by any retailer I go to.

So the areas where we compete and the areas where we cooperate need to be better defined.

FULLMER: One of the areas that we have difficulty with in today's marketplace is how we are going to take care of those who have no insurance, or provide appropriate care, timely care, primary care, that will reduce the overall costs if we look to the long run? It's increasingly on the hospital's side and on the provider's side and increasing the cost, and that creates, I think, a little bit of tension with the insurance industry, which just wants to pay for their subscribers. And yet we have this huge, as I understand it now, some 40 million uninsured people in the country.

Richard, do you want to comment a bit in regards to this topic, how issues such as any willing provider and also freedom of access might affect the business aspects of healthcare?

DR. SPERRY: I'll think about that while I'm responding a little bit more globally here. I think that all sectors of the healthcare economy, if you will, would be served by improving the efficiency of our healthcare system: That we don't deliver care that is not needed and that when we deliver care, the care that we deliver is done in as a cost effective manner as possible. If we could address those two issues, it would free up a considerable amount of money from the healthcare system and relieve the stresses and burdens placed on businesses, families, tax payers and voters.

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Getting back to the insurance coverage and the segmentation in the market that comes from insurance products that exclude providers. I think the important perspective to consider is the perspective of the patient. There's no question in my mind that exclusive contracting, while financially advantageous for some patients, is significantly disruptive to their healthcare. It forces them to find different providers as contracts switch.

On the other hand, I think expanding access widely for an insurance product for all providers just across the board probably makes it more expensive and may compound the problem that we are trying to solve and that is getting the most value for our money and making it affordable to subsidize those who are uninsured. It's a two-sided issue. It's a difficult question.

JOE, IF I COULD ASK FOR YOUR COMMENTS IN TERMS OF THE UTAH HOSPITAL ASSOCIATION, THERE'S BEEN SOME FAIRLY RECENT NEW HOSPITAL CONSTRUCTION THROUGHOUT THE STATE. HOW DO YOU SEE THAT AFFECTING THE CARE AND THE FINANCE OF HEALTHCARE AS A WHOLE IN UTAH?

KRELLA: It's a challenge and it's an opportunity. We are seeing the recent construction as a result not only of keeping up with modernization and technology and replacement of facilities, it's a result of population growth. At the same time, you've got to balance that need to meet the population expansion and the needs of the community with access to capital. How do we keep up with it when we have a growing population for which there is no reimbursement and we've got challenges from...

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