By Mary Grealy. This past Sunday, Ezra Klein had a fascinating piece on the Washington Post website regarding the Cleveland Clinic (a Healthcare Leadership Council member) and its efforts to achieve a higher degree of wellness within its workforce.

In Cleveland, Clinic CEO Delos Cosgrove has essentially declared war against preventable chronic disease.  Smoking is completely banned anywhere on the campus (and, in fact, physicians have been fired for violating this prohibition), deep fryers and sugared sodas have been removed from the Clinic premises, and Clinic employees pay higher health insurance premiums if they don’t take part in some form of fitness or stress management classes.  Employees’ health conditions – blood pressure, blood sugar, weight and other measurable – are monitored to make sure they are being proactive in improving their health.

The results, as Klein writes, are indisputable.  The Clinic has reduced its employee healthcare costs.  Smoking rates and blood pressure are way down.  Employees have lost a collective 125 tons of weight since 2005. (more…)

By Mary Grealy. Yesterday, USA Today devoted its front page to a topic many of us have been discussing intensely for some time – how to address Medicare’s escalating costs. 

The newspaper listed five ways to “squeeze” Medicare spending and then discussed the political arguments for and against each.  Some, such as gradually raising the Medicare eligibility age from 65 to 67 and requiring higher-income beneficiaries to pay full premiums for their Medicare Part B (physician services) and Part D (prescription drug) coverage are recommendations that the Healthcare Leadership Council has made to the congressional deficit reduction “super committee.”

But, in a number of ways, the USA Today article missed the mark:

In discussing cutbacks to Medicare providers, including physicians, hospitals and pharmaceutical companies, the newspaper expanded on the likelihood that those health sectors would strenuously argue against any cuts, but there was no reporting on the impact those reductions would have upon beneficiaries.

This is a pet peeve of mine, as I’ve noted previously.  Too often, both politicians and commentators speak of the value of cutting providers instead of patients, obscuring the fact that reduced payments to providers has an impact on both the accessibility and quality of healthcare.  If, as the Obama Administration has proposed, pharmaceutical companies are required to send over $100 billion in rebates back to the government, can there be any other outcome besides higher prices for consumers and less money available for research and development of new innovative medicines? (more…)

By Mary Grealy. When we talk about people who don’t have access to healthcare, there’s a natural assumption that it’s because they can’t afford it.  A new study shows that’s not necessarily the case.

According to the study published in the journal Health Services Research, 21 percent of American adults said they had delayed care for non-financial reasons compared to 19 percent that cited cost as the primary reason for not seeking healthcare.

Those non-financial reasons included not being able to get to a doctor’s office during working hours, long commutes to the medical office, or not being able to get an appointment soon enough.  As the study’s lead author said, “In reality, there are all kinds of reasons why people can’t get the care they need when they need it.”

There are at least a couple of important points to take from this report.  One is that healthcare providers have to continue exploring creative ways, from telemedicine to non-traditional office hours, to meet the needs of today’s patient population. (more…)

By Mary Grealy. I wonder how long it will take before people who should know better stop implying, or even saying outright, that payment cuts to Medicare providers don’t affect beneficiaries.

This weekend, I was among those following the cable news shows to see if Congress would finally reach agreement on a debt ceiling package.  It appears now that, even though it may be a “sugar-coated Satan sandwich” to some, a legislative approach has been crafted that will raise the debt ceiling and establish a process for achieving approximately $2.5 trillion in budget cuts over 10 years. 

In this process, a congressional super-committee will be charged with identifying $1.5 trillion in deficit reductions by Thanksgiving.  If they fail to do so, automatic cuts will occur and fall most heavily on the defense budget and Medicare.

As I was watching the news analysis, though, I saw a continued misunderstanding of what it means to cut Medicare provider payments.  One commentator praised the deal for protecting the most vulnerable in society, pointing out that Social Security and Medicaid were exempt from cuts, and Medicare cuts “would only affect providers.’  We’ve seen the same type of analysis several times today in print reports.

This kind of verbage creates the impression that an acceptable way to reduce Medicare spending, in a way that doesn’t do harm to patients, is to ratchet down payments for physicians, hospitals, medical devices, pharmaceuticals and medical supplies. (more…)

By Mary Grealy. It’s easy to get so caught up in the battle over whatever healthcare legislation is before Congress, or the newest set of regulations to come out of the departments and agencies, that one can make the mistake of thinking that all healthcare reform has its genesis within the confines of Washington, D.C.

The truth, though, as spelled out in forceful detail by McKesson Corporation CEO John Hammergren (a Healthcare Leadership Council member) in a Forbes blog post this week, is that genuine, system-changing reform is taking place up and down the healthcare spectrum outside of the Washington Beltway.

His sound advice to his counterparts in the healthcare industry is simple and compelling:  Don’t wait for Washington to enact change.  Make it happen yourselves.

Mr. Hammergren cites hospitals and insurers that have reduced costs and improve the quality of patient care through sound use of information technology, adherence to evidence-based medicine and innovative delivery approaches and management techniques.  As he writes, “Disciplined leadership and visionary planning turn intractable problems into exciting opportunities.”

Actually, the Healthcare Leadership Council is bringing that argument to government policymakers.  Our HLC Value Compendium cites numerous examples, with the metrics to back them up, of private sector healthcare companies and organizations taking steps to improve the value of healthcare and improving patient outcomes.  We believe these success stories can be a springboard for the Center for Medicare and Medicaid Innovation’s efforts to develop successful payment and delivery reform demonstration projects. 

In the meantime, the next time we get caught up in the latest health policy political spat that has everyone inside the Beltway talking, we should remember the message in Mr. Hammergren’s Forbes post.  What’s happening everyday in healthcare venues throughout the country, he writes, “is the kind of reform that no one will want to repeal.”

Originally posted on the Prognosis Blog on June 9th.

By Mary Grealy. It wasn’t a head-to-head battle, as such, but Congresswoman Allyson Schwartz (D-PA) squared off against the USA Today editorial board yesterday on the subject of the Independent Payment Advisory Board (IPAB), and I believe the lawmaker clearly made the better arguments.

USA Today’s editorial made the point that the IPAB, created as part of the Affordable Care Act to curb Medicare costs, is essential to do the job that Congress won’t in cutting program spending.  The newspaper compared the new board to the base closing commission that successfully shuttered unneeded military installations.

That’s a dubious argument, though, at best.  The base closing commission carefully studied the value and usefulness of military bases before choosing which ones could be closed without undermining national security.

IPAB will function in a completely different way.  If Medicare spending goes above arbitrary levels, then the board will bring the ax down on program budgets without regard to quality, value or seniors’ access to healthcare.   We’re facing a near future in which the senior population will be rising in number while physicians will be in shorter supply.  Simply cutting provider payments is the wrong answer.

Congresswoman Schwartz, in her response, acknowledged that Medicare costs must be contained, but she wrote that the solution is to reduce costs through innovations in health delivery to “reduce errors, eliminate duplication and waste, use technology to safely share information, and coordinate care between practitioners and settings.” 

She said it best when she wrote, “The threat of reduced payments is the least imaginative option.”  She’s absolutely right, and Washington can and should address the Medicare cost issue more creatively and effectively without diminishing healthcare for those who need it most.

Originally posted on the Prognosis Blog on May 24th.

By Mary Grealy. At this moment, there appear to be few issues that have elicited as much partisan rhetoric as Medicare reform.  Ever since Congressman Paul Ryan (R-WI) released the House Republicans’ 2012 budget proposal – a proposal that includes a transition of Medicare to a “premium support” model, in which the federal government will provide a financial contribution to assist beneficiaries in choosing from a list of private health coverage plans – there has been a pitched battle in the media between Democrats and Republicans over whether such a change would mean essentially an end to Medicare and be harmful to beneficiaries.

But the Washington Post reminded us this weekend that the premium support concept has its roots in bipartisanship.  The idea was, in fact, endorsed by the Bipartisan Commission on the Future of Medicare, which did its work in the late 1990s.  One of the co-chairs of that commission, then-U.S. Senator John Breaux (D-LA) championed the approach, saying “Medicare as we know it is going to end by itself if we don’t make some changes.” 

More recently, Alice Rivlin, President Clinton’s budget director, worked with Congressman Ryan on a bipartisan premium support proposal when they were both members of President Obama’s bipartisan deficit reduction commission (although she makes it clear that she does not support the current Ryan plan).

Senator Breaux and I have served together as co-chairs of the Medicare Today coalition, a group that helps provide information to seniors about the Medicare Part D prescription drug benefit.  Senator Breaux has told me that his work on the Part D issue has convinced him that seniors value the ability to make their own healthcare decisions, including a choice of coverage plan, and that supporting this freedom of choice really should be a bipartisan objective.

It isn’t bipartisan today, but we can only hope that as work continues on making Medicare sustainable for future generations, we’ll rediscover the bipartisanship that existed on Senator Breaux’s Medicare commission and see Democrats and Republicans working together to make changes the program needs to live on for future generations.

Originally posted on Prognosis on May 2nd.

By Mary Grealy. An interesting comment was made today at the annual national health research forum sponsored by the non-profit organization Research! America, and it drove home the conflict lawmakers face in trying to balance deficit reduction against the need for quality healthcare and better preventive care.

Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said that the ideal American, from a budget standpoint, “is one who dies at age 65 on the drive home from his retirement party.”  His comment gets to the heart of the budget conundrum.  If our healthcare system takes steps to help people live longer in their retirement years, then they consume more Social Security and Medicare resources.

Yet, as Frieden also said, we should all be able to agree to the societal goal that “Americans are better off not dead.”

There are some important points here.  First, that there is not necessarily a perfect alignment between budgetary goals and the imperative to have a healthy population, that funding for medical research and the effort to prevent and cure disease should not be viewed in the same vein as other areas of discretionary spending.  And, second, as Frieden also pointed out, investments in disease prevention do not always fit into the neat, tidy 10-year window that Congress and federal budgeters like to use to score spending, that health prevention measures can sometimes take 20 or 30 years to fully assess their return on investment.

At the same Research! America event, former Congressman Mike Castle said that the need to contain Medicare and Medicaid costs will be one of the major campaign issues in the 2012 elections.  No doubt he’s correct, but let’s hope we hear office holders and candidates provide some creative solutions on how to curb cost growth while still achieving the greater objective of keeping Americans alive and healthy.

First posted on the Prognosis Blog on March 15th.

By Mary Grealy. There’s no question that, if we’re ever to have effective health reform in this country, improving our healthcare delivery system has to come through a public-private partnership.

One of the key elements of the Affordable Care Act is the creation of the Center for Medicare and Medicaid Innovation (CMMI), an entity that will be charged with evaluating concepts for healthcare delivery reform and then putting into action demonstration projects that have the potential to improve healthcare quality and increase cost-efficiency.

Fortunately, much of this ground is already being broken in the private sector.  Throughout the country, hospitals, pharmaceutical companies, medical device manufacturers, group purchasing organizations, insurers, distributors and other health sectors are succeeding in developing new practices and technologies to improve patient care, control costs and promote value.

At the Healthcare Leadership Council, we’ve compiled a number of these examples, with supporting metrics, and provided them to Center for Medicare and Medicaid Services administrator Dr. Don Berwick.  We call the document the HLC Value Compendium.

The purpose of the publication is spelled out in the forward that McKesson Chairman and CEO John Hammergren and I wrote.  It says, “This compilation has a definite and important purpose.  The promising work being performed by private sector healthcare organizations can serve as models for policymakers seeking to inject innovation into public programs and thereby moving our nation’s healthcare system to one more strongly defined by quality and cost-effectiveness.”

Originally posted on February 3rd on the Prognosis Blog.

The following was originally posted by Disruptive Women Mary Grealy on the Prognosis Blog last Friday. Even though it was written prior to yesterday’s vote to repeal health care reform by the House the message is still relevant, if not more so.

By Mary Grealy. Next Wednesday, the U.S. House of Representatives is scheduled to vote on legislation repealing the Affordable Care Act that the 111th Congress passed just last year.  Presuming that the U.S. Senate will not follow the House’s lead, next week’s vote begins what could be a very difficult and contentious process to determine the future of health reform.

As lawmakers, as well as those of us who advocate various policies and points of view, start down this road, we would all do well to take David Brooks’ column in today’s New York Times to heart.

Brooks writes, as so many have in recent days, on the need for greater civility in our political discourse, but he takes it a step further and says that civility won’t come unless we each begin to recognize our own fallibility and that we achieve more through collaboration and cooperation than by going it alone.

He writes, “…even if you are at your best, your efforts will still be laced with failure. The truth is fragmentary and it’s impossible to capture all of it. There are competing goods that can never be fully reconciled. The world is more complicated than any human intelligence can comprehend.

“But every sensible person in public life also feels redeemed by others. You may write a mediocre column or make a mediocre speech or propose a mediocre piece of legislation, but others argue with you, correct you and introduce elements you never thought of. Each of these efforts may also be flawed, but together, if the system is working well, they move things gradually forward.”

It’s unfortunate that the health reform process from the beginning turned into a rhetorical battle of absolutes.  To this day, among politicians and pundits alike, either you’re for the Affordable Care Act or you’re against it.  The debate has always been framed in terms of all-or-nothing stakes.  Yet, who can reasonably argue that a measure this complex wouldn’t have both flaws that need correcting and positives worth preserving?

When Congress finishes its action on repeal legislation, it would be a positive step to see a broad acknowledgement that health reform can be made better if it incorporates the best ideas from both parties, that we need to expand coverage, achieve greater affordability and promote a vibrant role for private sector innovation.

A Rasmussen survey released today shows that only 18 percent of the American public wants to see the health reform law left in place as it is.  Yet, surveys also show that voters don’t want to see reform scrapped completely.  It’s not healthy to have the public so bitterly divided on an issue of such vast importance.  I’m no pollster, but I suspect there would be widespread public approval if all sides decided to, as Brooks wrote, acknowledge their fallibility and work together to craft genuinely bipartisan, effective solutions for our nation’s healthcare system.

By Mary Grealy.  In recent years, there has been nothing particularly innovative about the way we’ve developed health policy in this country.

As was fully displayed during last year’s health reform debate, health issues have generated confrontation, shouting, posturing and hard divisions between opposing camps with cooperation and compromise nowhere in sight.  Even when solutions emerge from this acrimonious environment, they don’t enjoy consensus support from the public.

As we look at the issues that affect the future of American medical innovation, we can and must do better.  Whether we’re talking about payment reform, better means of health care delivery or the development of new drugs and devices to combat the growth of chronic disease, it’s critical that we encourage innovation as a means to make health care better and more affordable.   Instead of always blaming technology for runaway health care costs, how should policymakers distinguish between innovation and other factors that impact health costs (ie, rising rates of chronic disease and the aging of our population)? Instead of yelling at each other, we need to find ways to bridge our differences and make genuine progress toward the objectives our society needs to achieve.

That’s why the Healthcare Leadership Council, a coalition of chief executives from all sectors of American health care, has launched the National Dialogue for Healthcare Innovation (NDHI).  Co-chaired by Dr. David Barrett, the CEO of the Lahey Clinic, and Bill Hawkins, the chairman and CEO of Medtronic, the NDHI is an effort to create a forum in which health leaders with diverse views can sit down together to better understand each other’s perspectives and start the process of building consensus.

The first NDHI event took place on October 4, 2010.  Its focus:  a summit on physician-industry collaboration.  This is the kind of complex, important and potentially thorny issue NDHI was created to address.  The health care industry has a history of working with physicians to gain the expertise necessary to ensure that new medications and medical devices are safe and effective for patients.  Yet, there are concerns about conflict of interest issues and the need to make these industry-physician agreements fully transparent. (more…)

By Mary Grealy.  An organization of health industry chief executives today applauded federal regulators for being responsive to the concerns of hospitals and physicians in constructing the final “meaningful use” regulations that will determine the allocation of health information technology (HIT) incentive funds.  But, said the president of the Healthcare Leadership Council (HLC), the newly-released rules leave some critical issues still unaddressed.

HLC president Mary R. Grealy said that, even though her organization was still analyzing the regulations, “it’s clear that federal regulators paid close attention to the more than 2,000 comments they received on the proposed rule, and that they have been responsive to concerns that the initial regulations placed the “meaningful use” bar so unrealistically high that the health technology revolution would have been slowed instead of accelerated.”

The “meaningful use” regulations establish standards that health providers must meet in order to qualify for a share of the more than $27 billion authorized by Congress in last year’s economic stimulus legislation.

The Healthcare Leadership Council is a coalition of chief executives from all sectors of American healthcare.

Ms. Grealy said, “An example of this responsiveness is seen in the fact that the rules no longer require that, in the initial stage of implementation, all of a health provider’s administrative transactions must be included in an electronic health record.  That simply wasn’t realistic.  Those requirements are now in Phase 2 of implementation, which is achievable.”

She said, though, that legitimate concerns remain.  For example, the regulations should consider each campus of a multi-campus hospital system as a separate entity in qualifying for HIT incentive payments.  And, she said, health providers who have built and succeeded with their own information technology systems should be grandfathered into the universe of successful “meaningful use” qualifiers, but that doesn’t appear to be the case based on an initial review of the rules released today.

Nonetheless, Ms. Grealy said, “we’re seeing important progress with these regulations.  Clearly, the administration saw there was a gap between the theoretical standards they initially wanted to apply and the real-world challenges that physicians and hospitals face in achieving HIT advancement.   We all want the benefits that come from information technology – enhanced patient safety, more cost-efficient operations, greater use of evidence-based medicine – but to make strides forward, regulators and providers need to be moving at a coordinated pace.”

Orignially posted on Prognosis: A Healthcare Blog on July 13th

It could not escape notice this week that the Virginia state Senate passed legislation that would make it illegal for any government body to require individuals to purchase health insurance.  The bill is expected to be passed by the state’s House of Delegates and then signed into law by Governor Bob McDonnell.

Virginia is one of the first states to take such action, but it almost certainly won’t be the last.  According to the American Legislative Exchange Council, legislative measures or proposed constitutional amendments have been filed in 35 states to challenge the idea of health insurance mandates.

This is a significant problem for the future of health reform.  One of the most popular components of the health reform bills that have passed both houses of Congress is the provision that removes pre-existing health conditions as a barrier to purchasing health coverage.  Even in our fractious society, there is virtual unanimity around the idea that having an illness shouldn’t leave individuals and families without health insurance and subject to financial ruin.

But we can’t enact that essential reform unless we also take steps to ensure that there is an individual responsibility to have health coverage.  Just as our property insurance system would collapse if individuals could wait until their house is on fire to buy a homeowners’ policy, so would our health insurance system be unsustainable if the healthiest among us could opt out until we became ill and needed an insurance plan to cover their expenses.

Understandably, lawmakers, in a challenging political environment, would love to pass laws making insurance companies issue policies to all comers, but they’re reluctant to impose health insurance mandates on their constituents. This, however, is a case where you genuinely can’t have the dessert without the vegetables.

(more…)

Mary R. Grealy is president of the Healthcare Leadership Council, a coalition of chief executives of the nation’s leading health care companies and organizations.  She is also the author of Prognosis:  A Healthcare Blog which explores the nexus at which healthcare policy meets healthcare practice.

If only it were an urban legend that senior citizens in the United States were cutting their physician-prescribed pills in half or ignoring their medications altogether in order to have enough money for food and utilities, but one doesn’t need academic studies to know that this kind of economically-forced non-adherence has too often been the case in our country.

After Congress passed the Medicare Modernization Act (MMA), creating the Part D prescription drug program, the Healthcare Leadership Council – an advocacy group comprised of chief executives of healthcare companies and organizations from all health sectors – literally took its show on the road. Having worked for passage of the MMA, we felt a responsibility to ensure that the new Part D program was implemented successfully and that seniors knew how to take advantage of the new benefit.

In community meetings across the country, I met with scores of elderly men and women who told me heart-wrenching stories of the hard choices they had to make between medications and other necessities, knowing they were putting their health at risk.

Has the Medicare Part D prescription drug program made a difference in drug adherence within this vulnerable population? The results are quite positive but they also show that further improvements remain necessary.

The impact of Part D on drug adherence among the elderly is unquestionable. A survey in April of this year by KRC Research (commissioned by Medicare Today, a coalition of local and national organizations we founded to provide reliable Part D information to seniors) found that three of every 10 Medicare beneficiaries reported that they are now taking medications that they had previously either skipped or rationed.

(more…)