Keynote Sessions at the 6th Annual WHCC

Well, it’s hard to do any “real-time” blogging with no plug for my laptop and no Internet access. I’m glad I actually began to try Twitter the other day. Here were the quick Twitter updates that I threw out there. To see all the “tweets” about the conference, you can go here (#whcc09).

1. Information transparency is a waste of time if you don’t have choices. #whcc0927 minutes ago from txt
2. Audience smiled less, gets less sleep, and less happy via gallup well-being survey done before event. #whcc0931 minutes ago from txt
3. India $14 pmpy hc costs. #whcc09about 1 hour ago from txt
4. Consumer reports rolling out safety and effectiveness comparisons to site tonight. Could be big deal and big first step. #whcc09 about 1 hour ago from txt
5. #whcc09 highest selection on data to disclose is providing information on comparing mds (via audience poll). about 1 hour ago from txt
6. Are consumers really willing to trade convenience for savings and broader coverage? Not real til it affects me. about 1 hour ago from txt
7. #whcc09 healthcare is either engine for growth or anchor about 2 hours ago from txt
8. #whcc09 ceo of kelly svcs says surveys show that greatest issue to starting company is access to hc about 2 hours ago from txt
9. #whcc09 – ceo of wpt just said they sold nextrx to esrx as a way to lower costs. True in economy of scale perspective. What about coor …about 2 hours ago from txt
10. #whcc09 only 10% of audience believe costs will be managed with legislation in 10 years. About 50% skeptical. about 2 hours ago from txt
11. #whcc09 – reform w/o public plan an option if meet admin’s 8 objectives. about 3 hours ago from txt
12. #whcc09 – MA connector has 80% of purchases online in under 25 minutes. Will broker model die? about 3 hours ago from txt
13. #whcc09 person from MA connector – waste is someone else’s income – one challenge. Their trend is only 5%. Not bad. about 3 hours ago from txt
14. #whcc09 bs of ca ceo – hc is a right. Can’t achieve coverage w/o controlling costs. Involve constituents more often. about 3 hours ago from txt
15. #whcc09 good speaker from administration…laid out principles…no secret sauce…costs, quality, coverage about 3 hours ago from txt

These are my notes from the sessions. As time allows, I will work on some “stories”, but I thought I would share this.

Dr. Hughes from the Obama administration:

• HC costs are “crushing the budgets” of families and government
• Businesses finding it difficult to maintain coverage and be competitive internationally
• HC reform not just a moral imperative but an economic imperative (Obama says)
• Not whether every American deserves coverage but how we get there
• How we get there
  • Expand coverage
  • Prevention and expansion of public health
• Hosting of localized healthcare session – 9,000 volunteers; 30,000 participants; 4,000 reports
  • Very similar findings
  • Affordable, high-quality coverage
• CHIP plan
• American Recovery and XXX Act
  • Billions for research and other health priorities
    • $19B to modernize system w/ HIT
    • $1.1B comparative effectiveness
    • $1B Prevention
    • $2B Community Health Centers
    • $500M for health workforce training and education
  • $87B to states for Medicaid and CHIP
    • Protect 20M Americans
  • HC tax cut of 65% for COBRA
    • 7M Americans
• $630B healthcare reserve fund for next 10 years
  • 50/50 by increasing revenue and cutting costs
    • Tax the rich
  • Reduce overpayments to MA
  • Reduce drug prices
    • Expanding access to generics
    • Follow-on biologics
  • Medicare / Medicaid payment accuracy
  • Improving care for those that have been hospitalized
    • 1/5 Medicaid rehospitalized w/I 30 days
  • Align incentives for quality not just quantity of services
  • LT investment
• No written plan…approaching with open mind to collaboration
• President has endorsed 8 principles
  • Protect family health
  • Affordable
  • Prevention
  • Quality and safety
  • Portability
  • Choice of MDs
  • No pre-existing conditions
  • End LT health cost growth for business

Bruce Bodaken – CEO of BS California

• Lessons learned from failed CA experiment
• Principles:
  • Healthcare is a right (can’t turn a blind eye)
  • Can’t achieve coverage w/o controlling costs
• Been working on CA legislation since 2002
• Need to touch base w/ constituents more often
• Need unions and business in lock-step
• May not want to take this all on at once [big bang vs. incrementalism]
• Can’t be globally competitive w/o addressing cost issue
• The right time to see this happen…”capture the moment”
• Change happens when things are up in the air

John Kingsdale – MA Health Connector

• Moral challenge that the country has to win
• Passed 198-2 in MA (across both houses)
• Bit of genius to how they did it
  • Bit off what they could chew
  • Almost universal (2.6% uninsured)
  • Universal insurance in Europe is closer to 1% uninsured
• Costs no more worse than CA and other places
• Didn’t worsen costs (5% annual trend)
• Didn’t do radical attack on costs…health care reform 2
• Pay ~600% more than industrialized countries for administration of health
• Pay ~300% more per day in hospital than other countries
• “Waste is someone else’s income”
• Moving away from fee for service model
• How does the federal government do it in depth of recession?
  • Premium increases still going up 10% while in recession / depression…how is that possible.
• Connector
  • Educate and inform buyer
  • Put forth high value option
  • Facilitate comparison for “shopping”
• Connector can create a modern way to distribute health insurance…but this will threaten some of the existing players [i.e., brokers]
  • Should be all online
• 80% of their purchases are online in 20-25 minutes

Q&A:

• Need for bi-partisan support. What’s president’s perspective – important or will he ram it through?
  • Wants bi-partisan support.
  • President will do what he has to do to get it passed.
• One of the big elements of discussion is having a big public plan. Does it drive private plans out of business? Don’t take away from what people have. How does administration think it will play out?
  • There are lots of good plans out there. Administration open to change / discussion. Plan doesn’t have to have public plan if it meets his 8 objectives.
  • Having regulation w/ teeth important. Risk pool vs. head-to-head competition.
  • Proposals for single payor in CA has failed multiple times.
  • Need to do something other than putting ½ T business out of business

Audience Polls:

• Believe legislation will be passed
  
• 50% believe we will make marginal progress in next 10 years
  
• ~ 50% feel that cost mgmt unlikely
  
• 40/40/20 audience split btwn republican/democrat/independent
  

Second Session – Facilitated by Vanessa Fuhrmans (WSJ)

Health and Money

Angela Braly (WPT), Carl Camden (CEO of Kelly Services), and Mark McClellan (Brookings Institute)

Audience Poll: 42% believe individuals should pay the most for HC

Angela:

• Jeopardy question ” what does WPT provide to 1 in 9 americans?” answer was life insurance which was wrong
• Needs to be a game-changer.
  • Need solution for uninsured
  • Don’t think gov’t plan is the right answer
  • Think need to make changes in individual market
  • Enforceable
  • Reward healthy behavior
  • Guaranteed issue
  • Focus on cost and quality
• Sold PBM since it’s a way to drive to lower cost

Poll – what % of 17M adults going to MD will receive recommended course of care – 55%

CEO of Kelly Svcs

• 26% of workforce is “free agent”
• Expected to grow dramatically
• The group that produces the most new business start-ups
• US falling behind others in start-ups per 1,000
• Greatest impediment to starting business in US survey is access to HC
• Total costs of employment in US is driving move to offshore
• Question should we where jobs are growing vs. whether companies moving offshore

Mark McClellan:

• HC can be engine for growth or anchor
  • Is spending getting more or due to inefficiencies?
    • Life expectancy goes up 1 year per decade
• Have to change the system not just buy more people into the current system
• Lots of examples of getting much more with less
  • Cleveland Clinic
  • Geisinger
• Key steps:
  • Major emphasis on measuring quality and cost
    • Consistent, meaningful, patient level, outcome based
  • Create accountability in payment systems and benefit systems

Audience Poll – Do you support reforms to the current payment system – 82% support major reform.

Audience Poll – Do you support reforms to the current delivery system – 84% support major reform.

Audience Poll – Would you still support if it affected access to your md, policies and cost – 67% yes. [this is a major variance from public response]

Angela – Private insurers will take proactive role in driving healthcare payment reform. Aligning reimbursement w/ outcomes may be the result. Compensating for prevention is important.

Mark – Lots of worry about comparative effectiveness being over simplified and mis-applied.

Mark – Need to focus on value in HC.

Angela was asked the “tough” question on why hasn’t healthcare reformed itself. I thought she had a great answer…”because people want convenience”. Members don’t want to have smaller networks or restricted access. They want everything, but at a lower cost. [Not a likely scenario.]