Long before healthcare reform, medical home, and quality metrics became today’s buzz words, there was the Buyers Health Care Action Group (BHCAG).
Founded in 1988, the coalition of large Minnesota companies, including 3M, Target, Medtronic, Best Buy, and General Mills, pioneered concepts of paying doctors for good performance and promoting transparency in the quality and value doctors and hospitals provide to patients.
Much of that work can be found in Minnesota’s own reform efforts: paying extra money to providers who compare favorably to benchmarks measuring the quality of diabetes, heart disease and pneumonia care and allowing consumers to compare the cost and performance of all providers in Minnesota, a process known as peer grouping.
MedCity News sat down with the BHCAG president and CEO Carolyn Pare to discuss how employers feel about the federal health bill, consumers’ ability to purchase coverage on the open market, and the Minnesota Medical Association’s push back against the state’s peer grouping system.
What was the reaction of your companies to recently passed federal healthcare reform?
I think it presents challenges. We needed to have something happen. We have already proven that doing nothing has gotten to where we are. Not all of our members think it’s a good thing. They would prefer nothing happen because they think some of the provisions in the bill make it difficult for employers to participate in providing healthcare. They are going to have to comply with more regulation.
We keep on arguing on who’s responsible on the payer side on the high cost of healthcare when really a lot of it is about what’s going on the supply side. There’s just not enough dialogue on that. Having said all of that, the good things about the bill’we’re talking about Innovation Centers, going beyond just doing demonstrations in Medicare but actually doing pilots, adopting new strategies around payment and quality improvement, focusing on things like transparency. Some of this stuff is more consumer focused than we have allowed the industry to be in the past.
In the short term, I’m worried that we have so many purchases paying attention right now to the administrative things that they need to be taken care as opposed to the longer range “real reform” opportunities we have that I’m fearful we will miss our opportunity to influence the broader reform that can come from this bill.
Critics say the bill doesn’t do enough to tackle cost. What do you think?
Is it not enough? Yeah, you could say that. You could also say it’s better than nothing. You can say it’s a start. It gives some new energy to things that we would like to see happen around innovation in the areas of quality improvement, transparency, and payment reform, which are really critical. You got to start somewhere.
Should the employer-based healthcare system in this country should be scrapped?
The place that’s always helped the consumer is that by shopping through the employer they could get group rates. Assuming that we level the playing field, make it a consumer friendly place, give them the tools and information they need to be real buyers, then you wouldn’t need any third party intermediaries. You could go direct to the market. But we are such a long way in having the infrastructure to support the consumer that I don’t know how you are going to have the innovation needed in providing the tools to the consumer that you can take the employer out right now.
Some people say paying doctors for performance is akin to pushing education to teach to the test. What’s your reaction?
It’s going on right now. We just don’t talk about it. You wanna tell me that a doctor doesn’t prescribe based on what he gets rewarded for prescribing? This has been the topic of much press that doctors take kickbacks that they prescribed a certain way or they use certain devices or they do whatever because ultimately the industry influences them.
The same argument is being used against pay for performance. This is why standardized quality metrics are so critically important because it shouldn’t be based on who has the ear of either the doctor or the legislator quite frankly. It should be based on unbiased quality outputs so we can all agree on what the quality standards are, based on all of the evidence that exist out there from the medical perspective. That’s what we should be looking at when we gauge the quality performance of any provider of care or teachers. Study to the test? Who doesn’t study to the test?
Do we need to pay more to primary care doctors?
I challenge the assertion that we necessarily need to move more money toward primary case. Maybe primary care has outlived its usefulness. That sounds awful to say. But I think we need to challenge ourselves to rethink the way care is delivered.
It doesn’t necessarily mean we need more doctors that provide primary care. We need more advocates on behalf of patients to see that they get the care they need. Who knows where that will come from? People are going to approach the system based on what works for them. The payment should be rewarding for an optimal result. Let’s not talk about the primary care doctor. Let’s talk about a care team. And I don’t know what that looks like.
The Minnesota Medical Association managed to delay or water down parts of the state’s peer grouping system. Do you think the MMA presents an obstacle to reform?
I would have a disagreement that [doctor performance] information can’t be public to people make decisions. Steerage is the strongest way to get people to pay attention to quality. It would be better to educate people that first of all, there is variation in quality. And to steer themselves to a provider that’s best suited to take care of them.
To the extent that anyone would argue against increased transparency, I would be troubled by that. I think transparency is the best thing for all of us. Had there been more transparency, chances are this financial meltdown probably wouldn’t have happened. It’s very important that the box is open and people can decide what they need to do based on how they enter the system.
Will [the MMA] be a problem? I think this is normal. This is normal discourse. Anytime someone sees some kind of legislation come along that mandates something, it’s automatic that we will bristle against being told to do something that we’re not sure we understand or feel is equitable. I completely understand where they are coming from but I think at some point, we will all be on the same page on transparency and meeting the needs of the consumer.