Jack Friedman Suggests Single Payer System Would Be Ideal

Speaking at a conference organized by the Healthcare Information and Management System Society, the CEO of Providence Health Plans said it’s not going to happen

November 17, 2011 -- As healthcare costs spiral out of control, “Medicare makes Social Security look like chump change in terms of what it's going to take to get future liabilities funded,” said Jack Friedman, CEO of Providence Health Plans, the keynote speaker at the Healthcare Information and Management Systems Society conference earlier this week.

Several cost-cutting measures are under way at Providence -- increasing communication between providers to get best results, reducing fee-for-service payments and working with high emergency department users to reduce costs by increasing staffing on the nurse advice line.

Also, among patients who have back surgery, 15 to 20 percent have recurrent problems and don’t recover very well. Friedman wants to improve those outcomes by aggregating the data, then sharing the results with his physicians.

“When you give physicians the right information at the right time, with the right incentive, they almost always do the right thing,” he said.

Asked by an audience member what he considered the ideal size of a healthcare system, Friedman said, “If we honestly were starting from scratch, we'd probably go single payer. But I don't think we can get there from here.”

Work Force Changes

When it comes to improving the health of its work force, Brian DeVore, director of industry affairs at Intel Corporation, took the stage, and compared the search for a new delivery model for healthcare to innovation in technology: “It's only when Apple came out that we saw a shift,” DeVore said, saying there was little interest in personal computers until then.

Intel's human relations department wants to have the happiest, healthiest workforce – but to accomplish this, some basic things must be changed about the work environment, DeVore said.

“It's great that they make us an extra million dollars,” he said of Intel's engineers, “but that quadruple bypass may cost the company more than they will ever make for the company.”

Intel may adopt a health engagement model used by some employers in Oregon, and hire care coordinators to work with employees who have chronic health issues, creating incentives for them to seek primary, rather than emergency care.

DeVore also called for an end to the “arms race” of building new wings for specialty care, and instead develop a “Macy's-Gimbels” relationship among hospitals.

Administrative Costs Drive the System

Focusing on the healthcare transformation process under way, Sen. Alan Bates (D-Medford), a practicing physician, said this is a change long overdue.

Administrative expenses are driving up healthcare costs, including IT, he said, pointing to the mental health and drug and alcohol systems, where providers spend 50 to 60 percent of their time doing paperwork because of outmoded regulations.

Also, a minority of patients produce most of the cost, either because of genetic conditions or lifestyle issues, both of which can be dealt by focusing on preventive medicine.

Bates mentioned a patient he called “Mr. Smith,” a 55-year-old man assessed with a very low IQ and diagnosed with schizophrenia, who’d been having physical health problems. He was shuttled from one facility to another because the mental and physical health systems didn’t communicate with each other – and there wasn’t any way to coordinate his care.

The approach to create coordinated care organizations “can work. It must work,” Bates reiterated. Otherwise, the alternatives facing the state are either cutting reimbursement payments to providers or disenrolling patients from the Oregon Health Plan -- neither of which are desirable.

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Comments

What is single payer? It's a very prescribed way of paying for health care services. If we can't get all the way "there" from here, let's take the next step: a very regulated marketplace that provides a minimum set of health care services to all comers. That's essentially what ACA aka Obamacare does. We are getting closer so embrace these changes!

It is encouraging that a senior regional leader supports a single payor, universal health care model for the US. Virtually, every other industrialized country in the world utilizes some variant of the single payor model and the vast majority deliver superior health outcomes at 60% or less of the cost. Extending Medicare to all would serve to provide the US with an efficient single payer system. Getting there from here would require Congress to walk through a firestrom of lobbying by the special interests that protect our the fragmented health care status quo. J.M. Albrich MD

Socializing the payment system (single payer) without socializing the delivery system (doctors and hospitals - think VA here)) does little to curb health care costs. Even IF somebody could wave a magic wand and make it so, any savings from administrative consolidation would be eaten up in a year or two by unit prices of care, medication, devices, supplies, etc. The real problem is unit cost and wrong use. Some people get too much ineffective care, such as the example at the end of the article; other people don't get enough care of any kind. I don't know why doctors and hospitals have to be paid to "do the right thing" for patients (like coordinate care), but if that's the case, they will have to subject themselves to the payor (govt or private sector) that must make the rules about what the right thing is and how to get paid for it. And clearly, there have to be rules when you're talking about using OPM (other people's money).

One of the biggest roadblocks to healthcare change is fees charged by providers. Many people seem to believe that savings comes from paying providers less, but real healthcare improvement is derived from “best practices,” i.e., evidence-based care pathways that get the biggest bang for the buck. When outcomes are improved and less money is spent getting there, everyone benefits. Except providers. Healthcare providers often do not follow evidence-based guidelines, not because they are unaware of them but because they think they know better and because it is often more profitable not to do so. This holds true for managed care as well as fee-for-service plans, and it applies equally to hospitals, hospital-based healthcare plans, individual providers, and provider groups. When the best interest of the patient is put at the forefront of healthcare planning, outcomes will improve and costs will diminish. The medium necessary to the delivery of such care — single payer, Obamacare, or something different — is secondary to the main goal of getting and keeping people well. J. Michael Burke, D.C.

Health Care as a human right needs to be foremost on out minds. Do we or do we not deserve the right to stay healthy? What we deserve is making sure that the majority of us can do our jobs to the utmost for a healthy economy financially. The present health care system does not keep the basic human right in mind because of our capitalistic mind set which is not designed to have others in mind. We need to drop the idea of capitalism and profit when it comes to health care and begin to understand the healthcare as a human right makes more sense then profits is health care.