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As Minnesota U.S. Rep. Michele Bachmann accused President Obama of fraud in his health plan and her Republican colleagues continued to vow to kill what they derisively call "Obamacare," two executives from Minneapolis came to the nation's capital last week to explain the inevitability of some form of health care reform.
Blue Cross/Blue Shield of Minnesota CEO Pat Geraghty and Mark Eustis, CEO of Fairview Health Services, said they aren't waiting to try new approaches. They talked about their partnership in a program that changes the way patients receive and insurers pay for health care.
The model increases payments for good clinical outcomes for groups of patients rather than reimbursing doctors for each procedure they perform. It allows patients to pick among several health plans, preserving some freedom of choice in selecting doctors. It includes cost-saving innovations, such as online consultations with doctors in lieu of office visits, menus of services patients can buy and encouragement of advance directives to reduce expensive end-of-life procedures.
"Whatever comes out of a legislative process, we'll have to work with," Geraghty said in an interview. "And it will probably be mostly focused on access. But we knew that going after improving quality and controlling cost was going to be valuable and important and something that had to happen."
Geraghty and Eustis spoke at a national gathering of health insurers and health care providers who discussed ways to implement the legislation that Republicans vow to destroy.
The two-day meeting, sponsored by the trade group America's Health Insurance Plans (AHIP), revealed the limits of political rhetoric that suggests health care reform could be repealed. The Senate already has rejected the House repeal bill. Obama will veto any attempt to completely overturn one of his signature policy initiatives.
Furthermore, the political posturing doesn't deal with what Geraghty told the AHIP conference in behalf of an insurance cooperative covering 2.7 million Minnesotans: "We're tired of defending a broken health system."
Eustis, who manages a care network with more than 2,000 physicians that includes both the University of Minnesota medical school faculty and a large swath of suburban doctors, agreed. "As far as repeal of the bill, I don't think that will happen," he said in an interview. "There'll be some changes within the scope of what's there. There will be some funding changes. But the bill itself will be retained."
Even if it isn't, no U.S. health care system will provide adequate, affordable care unless it covers virtually every American, Geraghty and Eustis said.
Conservative groups and some Republican governors have challenged the individual mandate in the current health reform bill because it forces Americans to buy coverage or pay a penalty. The mandate has been upheld in some federal courts but not in others.
Geraghty and Eustis spoke the day after the Obama administration filed an appeal of a Florida judge's decision that the entire reform bill could not be implemented because the mandate is unconstitutional. Legal experts expect that the U.S. Supreme Court will ultimately determine the matter.
Geraghty and Eustis said the U.S. health care system is not sustainable without some kind of universal coverage.
The U.S. Centers for Medicare and Medicaid Services (CMS) expects national health expenditures to grow by an average of 6.1 percent per year from 2009 to 2019.
CMS says per person health care spending for Americans over 65 was $14,797 in 2004, "5.6 times higher than spending per child ($2,650) and 3.3 times spending per working-age person ($4,511)."
"In the picture we're looking at today, the mandate is an important component ... because it brings the healthier risks into the pool," Geraghty said. "What we need as a nation is a vehicle to get everybody covered .... At some point we're going to have to look at ourselves in the mirror and say, 'How are we going to bring health care to everyone?'
"If you don't have a mandate, you have to have other vehicles in place so you can create some balance and some equity in who's in the pool."
Added Eustis: "If you're not covered, you're not likely getting the services you need to improve your health. The people we see who aren't covered are using the emergency room, and we know that's not the best way."
That is why many in the insurance and care communities are skeptical of efforts to nix health reform and start over. Instead, many of those charged with implementing health care reform echo what Obama said in his State of the Union speech: Reform should and will be tweaked.
"Changes have got to occur," said Sam Crow, a physician who directs innovative care for Missouri-based Sisters of Mercy Health System, which operates more than 400 clinics and hospitals in the Midwest. "What we'll get is a hybrid."
What the country won't get, Crow predicted, is an outright repeal like the one the House of Representatives voted for.
Still, the repeal vote has caused confusion. At the AHIP conference, speakers from the government and the Congress could provide little detail on how insurers and care providers should apply regulations of the Affordable Care Act.
Geraghty and Eustis offered a model of reform that they said had been applied in Minnesota ahead of detailed government regulations. They believe the model will be adaptable to government health care reform, however it evolves.
It emphasizes preventive measures, such as reducing body mass index and quitting smoking. The program depends on a treatment team. Eustis projected a slide of a 70-year-old woman surrounded by her primary care doctor, a care coordinator, a social worker and her daughter.
"We're talking about a 20 percent reduction in cost in five years," Eustis said of the partnership with Minnesota Blue Cross/Blue Shield.
They're also talking about a major marketing effort.
Geraghty and Eustis see their collaboration, now used among privately insured patients, as an eventual solution for government-funded Medicare, which is threatening to bust the federal budget as baby boomers age. But as AARP government relations director Nora Super reminded, selling this plan to senior citizens who use Medicare could be as dicey as selling the individual mandate to the Tea Party.
"Remember the managed care backlash," she warned. "People thought something was being done to them," not for them.
Eustis said he can document an 80 percent reduction in hospital readmissions for certain patients because of the outcome-based approach. Still, he has yet to see satisfaction levels spike. They haven't gone down, he said, but they haven't gone up.
That's not necessarily bad Geraghty pointed out: "There's a classic change continuum that shows when you change something, typically you have a down trend in reaction and then you build from there," he said. "We haven't even seen a down trend. We've seen stability."
Jim Spencer • 202-408-2752