A model for getting and providing health-care services that assigns every person a medical home where prevention is the focus and patients actively participate in staying well received a hearty endorsement from a special panel of state lawmakers Thursday.
Members of the Legislature's Health System Reform Task Force couldn't find much wrong with the notion of assigning everyone a "medical home" that would in effect make the primary care physician the access point for everything from preventive screenings for diseases to specialized procedures.
Key to making the model work isn't just the way care is delivered or whether the 300,000 Utahns without insurance get covered, but the actions of every individual to get and stay healthy, lawmakers were told.
"We're basically getting what we pay for," said Rep. Brad Daw, R-Orem and a task force member. "Right now we're paying for a lot of care because we won't change our diet or other habits. People generally don't believe they can have much control over their health, and making them accountable for that isn't necessarily something people want."
Instead of more dire predictions of what can't be done to get health-care costs under control, lawmakers left their monthly meeting wondering why prevention and patient-based models being implemented by a few hospitals and care providers couldn't be expanded statewide. An economic disaster on par with the financial meltdown now under way on Wall Street is in the offing if the way things are done continues: Without a massive overhaul of the health care industry, top to bottom, from private, employer-based health plans to the price and quality of care provided, the amount of money spent annually per Utah household will equal the average household income in less than 10 years.
People could be given real incentives for progress they make, said Michael Magill, chairman of the Department of Family and Preventive Medicine at the University of Utah School of Medicine and founder of a coalition of providers investigating ways to increase quality and value of health-care services.
"The vehicle to change the delivery of health care is a market-driven initiative that promotes a continuing, one-on-one relationship with a primary care physician who can provide a continuum of care, possible health risks in collaboration with patients who are actively involved in staying well," he said. Robert Wheeler, a primary care physician and medical director for Regence BlueCross BlueShield of Utah, said medical homes are an example of how the system must undergo a fundamental transformation, not a reformation.
"There's been all kinds of interest in how to enhance the market of health care," he said. "The money goes for services rendered. There is gobs of information on the number and types of care that is purchased within the system. But there is a big disconnect on what happens to patients after the service has been provided."
Wheeler said medical homes have been compared to turning the system back to managed care. Medical care can have the most positive influence on a patient and best value for the money spent if it becomes a personal, ongoing, shared effort by a primary care physician in engaged collaboration with patients.
Proponents of medical homes say they wouldn't be tied to any single insurance or employer-provided benefit plan, and the few being tested currently don't require mandates for patient participation. But patients who do sign up with wellness plans of any kind offered by providers, hospitals, state agencies or city recreational programs are likely to abide by them and actually change risky behaviors if there were bottom line inducements. Premium prices and co-pay for doctor visits could be reduced, and money for making changes, such as so much per pound of weight lost entices people to health improving changes, they said.
David Sundwall, executive director of the state Department of Health, said patient behavior and attitudes run deep but aren't impervious to change.
"The phrase I heard most often and the one I hate the most to hear is, 'Whatever you say, doctor,"' Sundwall said. "I would way rather have a patient fully involved and fully participating, noting that most patients tend to be passive and want a quick fix with the least pain, cost and effort. These are not complicated changes in lifestyle that people would have to make," said Sundwall, who advises various health care organizations nationwide on individual responsibility. "They're simple steps, not even annual exams. Screenings for cancer risks, diabetes, blood pressure, steps that are critically important efforts to prevent illness.
"Seriously orienting toward prevention won't break the bank and still allow us to catch problems upstream before they become big, expensive problems we're paying for downstream," he said.
Lawmakers said that urging greater patient involvement in their own health is key to any reformed system, but it also sets up a delicate dilemma: How to induce people to be health conscious when habits they have and probably really don't not want to give up are the single biggest detriments to good health.
Mike Tanner, human resources manager at O.C. Tanner, said the jewelry manufacturing company has been incorporating the medical home model among employees by giving them reasons to participate for a number of reasons.
"We see as a business group that one of the biggest influences on the system's double-digit inflation is we've put the patient outside of the system," Tanner said. Low deductibles and low co-pays help create a sense that health care is a natural resource in infinite supply.
"For as much as health care costs, there is very little built-in personal responsibility paying for it or staying well."
The question is if the successes of these programs in place can be applied to all sectors of the system, said task force co-chairman Sen. Sheldon Killpack, R-Syracuse."Are we seeing a willingness on a major scale to change or are these models just another of a lot of small litmus tests that work in very specific situations but really don't fundamentally change the way things get done," he said.
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