Excerpts and Author Quotes
Introduction
HEALTH CARE REFORM NOW
Health care in the United States is functioning poorly and requires a broad consensus on an American-only solution providing universal, mandatory coverage that can be implemented now.
“With 47 million uninsured and runaway costs, a consensus is building among government, business, and advocacy groups that we must do something about our health care system. But the consensus falls apart when we try to figure out who pays for it, and how to reorganize the system.”
-- George C. Halvorson
Chapter One
A FEW HARD BUT USEFUL TRUTHS
Achieving health care reform requires an understanding of four key facts that should act as a foundation for our thinking so we can accurately identify the tools needed to improve the delivery of health care in America. These key facts are: uneven distribution of health care costs; care linkage deficiencies; economic; and systems thinking.
“We have over 9,000 billing codes for health care procedures, services, and separate units of care. There is not one single billing code for patient improvement. There also is not one single billing code for a cure. The economic incentive score is 9,000 to 0 – process versus results. Results get zero.”
-- George C. Halvorson
Chapter Two
DATA: THE MISSING LINK FOR HEALTH CARE REFORM
America can never raise the standard of health care systems without measuring and tracking performance of existing care. That requires electronic data, not paper records. The starting point for reform is computerized records and an electronic database that can be used for diagnosing patients as well as providing accountability.
“Anyone who truly wants to re-engineer and improve care should have the insight to know that the availability of data is foundational to care improvement and should therefore put market-based strategies in place that both reward and require the existence of that data.”
-- George C. Halvorson
Chapter Three
WHAT DO WE DO UNTIL THE EMR ARRIVES?
Changing all caregivers from a paper system to an Electronic Medical Records (EMR) system will take as much as fifteen years and $115 billion. But an electronic database of health records of individuals already exists on the computers of health insurance companies. That data is more useful because HIPAA now requires every physician and caregiver to have a unique provider number.
“Banks somehow managed to create a very workable voluntary data flow standard. So did airlines. Health care payers need to do similar work. If payers can’t achieve the same data transferability goal, relatively soon, the government should set those standards for everyone. The good news is – this is all very doable work.”-- George C. Halvorson
Chapter Four
BASIC STEPS TO IMPROVE CARE FOR CHRONIC DISEASE PATIENTS
We can actively intervene with chronic care patients to prevent the onset or slow the progression of their diseases. As a result, we can make a huge difference in both quality of life and costs of care for many people who otherwise will be our most expensive patients. The biggest cost savings come from preventing the acute care crises and intense medical complications that evolve from these diseases.
“We need community-based leadership to continue. We need campaigns to do things as basic as remove soda pop from school cafeterias and re-introduce physical education classes for students. Workplace exercise programs should be encouraged as well.”
-- George C. Halvorson
Chapter Five
EIGHT DEVELOPMENTS THAT FINALLY MAKE HEALTH CARE REFORM POSSIBLE
There are eight recent developments in American health care that have combined to give us, for the first time ever, a very real opportunity to systematically improve both care delivery and reduce the costs of care on a large scale in a relatively short time frame. Those eight developments are creating what might be a “perfect storm” in favor of health care reform.
“The emergence of a single provider number, electronic personal health records, data portability, and a sense by key parties that change is really needed all work together to set up the best environment and opportunity we’ve ever had for real health care reform in America. We just need to be very clear on what that reform should be. And we should be clear that we need that reform now.”
-- George C. Halvorson
Chapter Six
MAKING THE MARKET WORK FOR HEALTH CARE
Market forces actually do have a very powerful impact every single day on health care structure, delivery, and performance. We get exactly what we pay for and we get more of that than any health care economy in the world. We just pay too often for the wrong stuff. And a major reason we pay for the wrong stuff is that cutting overall health care costs is not an overarching goal for fee-for-service caregivers.
“Rhetoric will not make health care reform and a new market model happen. Wishful thinking will not make it happen. We need buyers to demand this kind of reform and then buy it. Market forces need to be used with cash attached in order to have any real-world impact on the actual delivery of care.”
-- George C. Halvorson
Chapter Seven
A NEW IDEA: THE INFRASTRUCTURE VENDOR
The key to health care reform in America using a market model will be for the buyers to hire infrastructure vendors (IVs) to set up the needed marketplace. The IVs will set up the mega-store environment for individual consumers purchasing care and will contract with health care providers for care and create care packages for employers.
“The uninsured need to be brought into the market model as well. Universal coverage needs to be the next major reform for American health care. It’s difficult to hold the entire care system accountable for care if the care-related data for 50,000,000 Americans will not be part of that data base.”
-- George C. Halvorson
Chapter Eight
WHO SHOULD RUN THE NEW HEALTH CARE INFRASTRUCTURE?
The new market infrastructure will not spring into existence of its own volition, and it will not be created without a sound business model. Someone needs to do the heavy lifting to make those market settings real. Candidates include government, major providers, major buyers, new entities, or administrators of existing plans, insurers, and benefits.
“The health care reform revolution needs to be buyer-led. Buyers have great skill levels for purchasing almost every other significant area of expense – so it’s time to extend that expertise to the purchase of coverage and care. “
-- George C. Halvorson
Chapter Nine
NEXT STEPS AND EXPECTATIONS
We need to know on day one exactly what we expect the fully functional future versions of this new model to be, and then we need to understand exactly how far we can go in year one, year two, etc. The new model will be rolled out in incremental stages, not all done in one fell swoop as a fully formed operation.
“We need vendors who sell both population health improvement and process re-engineering for care delivery. We need a data rich, choice-based health care marketplace facilitated by highly skilled infrastructure reform vendors. We need to pay those vendors for the success they achieve. If someone has a better idea, let’s talk.”
-- George C. Halvorson
Chapter Ten
COST SHIFT REALITIES
The uninsured do receive health care. The cost of providing care for the uninsured has to be met from some revenue source – so that cost is generally “shifted” to other payers. The keys are the amount of the cost shift, who pays for it now, and can that cost be better spent.
“If we put the right universal coverage program in place, we should be able to fund coverage for the uninsured by spending less money now then we currently shift to the private employers – with better, more accessible, and more cost efficient care provided to the uninsured.”
-- George C. Halvorson
Chapter Eleven
UNIVERSAL COVERAGE NOW
We cannot achieve total health care reform in America until we have health care coverage for every American. If we want systematic care improvement in this country, then everyone needs affordable access to systematic care. That will not happen until we achieve universal coverage.
“It’s definitely time to bite the bullet on universal coverage. The ethnic, racial, and economic disparities in care that exist now ought to push us all into creating universal coverage at the fastest possible speed – and the new opportunity to link universal coverage to real health care reform using electronic data about actual care delivery ought to give us a sense that the time to act is now.”
-- George C. Halvorson
Chapter Twelve
SO WHAT SHOULD WE DO NOW?
It’s time for reform. We as a nation must extend coverage to all Americans – funded by two dedicated taxes that will be highly visible and completely protected revenue sources. If universal coverage ends the current cost shift from the uninsured, the program could pay for itself in three years. One, two, three, free. That’s a good deal. It’s time to cover everyone. Now.
“Miracles cost money and we all want our miracles to happen. We also want them to be equitably distributed. To make that possible, we need a care infrastructure focused on results, empowered by science, and obsessively committed to systematic process improvement. We can create our own miracle. The time to start is now.”
-- George C. Halvorson
