Hearing of the Senate Finance Committee - The Right Care at the Right

Statement

SEN. RON WYDEN (D-OR): Thank you, Mr. Chairman, and Mr. Chairman, I want to start by commending you. You promised people at the summit that we were going to stay at it and continue these hearings. I think this is a great next round and a way to show we're going to continue to prosecute this cause of fixing healthcare.

I want to start with you, Dr. Orszag, if I might. You once again highlighted the extraordinary inefficiencies in the healthcare system. And I've come to the conclusion that the system is now so riddled so inefficiencies. I believe that the only way to bend the cost curve downward is to take two very concrete steps; one, to demonstrate to our people directly how much the inefficiencies cost, for example, in reduced take home pay.

And the second is to pass health reform legislation so that in a more efficient, fairer system our people have a new financial incentive to select healthcare carefully. Would you agree with that?

MR. ORSZAG: Yes. I like short answers.

SEN. WYDEN: You have analyzed the Healthy American Act, and I believe we take those two steps; give people a real sense of what they lose in wages, and in effect make it possible for them to see the financial incentive. Would you agree that the Healthy Americans Act -- the 16 senators take those two steps?

MR. ORSZAG: Yes, although there are also other ways of taking those steps also, but yes.

SEN. WYDEN: Well, that has really been my view, is that now we have at least one way of getting there. I share your view that there are a lot of other ways, and that's what under Senator Baucus' leadership and Senator Grassley's leadership we're going to explore, but you have now identified -- and it's good to have it on the record that there is one way to actually bend the cost curve downward and squeeze out some of these inefficiencies, and I thank you for that.

My second question deals with you other three panel members, who've done such great work in this field. When I get around the country and talk about innovation and quality, people say by god, they're doing a great job at Kaiser. They're doing a great job at Inner Mountain. They're doing a great job at (NAIO ?). But how do we take those lessons from those terrific programs and make them apply in small communities around the country where there isn't that network of integrated kind of services?

So for you three, how do we take some of these lessons from programs -- and I'll start with you, Dr. Halvorson -- and export them around the country? Take small towns in Oregon.

DR. HALVORSON: I have a long, long history of small town life, understand exactly what you're talking about. The issue for us is to prove that vertically integrated care can perform at a very high level in particular areas, and we're doing that. And the keyword there is integrated. And what we need for the rest of the country is vehicles and tools that accomplish that integration process. Chronic care is a team sport. Team sport needs a captain. Somebody has to be the integrator.

And in the small towns that integrator can be a computer system. It can be a care registry. It can be a local vertically integrated care system. There are different things that can be used, but that function must exist. If the function doesn't exist, coordination won't happen.

And so the challenge going forward from a policy perspective is how do you make sure that function happens every place in America where care is delivered so that there is a way of connecting the caregivers. And in my own sense, electronic medical records is -- when an electronic medical records feed that system, it's an optimal system, but you can also feed them from a claims database. You can feed them from other databases that are locally available.

But if you don't feed them from something and if there isn't a coordination function in the middle, then it cannot happen in small town America. So we need to move in that direction.

SEN. WYDEN: Dr. Wilensky, you want to add to that?

MS. WILENSKY: I thought that we were as a country moving more toward vertically integrated care in the 1990s, but I was wrong. Many people who have had an opportunity to do so, for whatever reasons, do not seem to have chosen it. Financial incentives may be wrong, et cetera.

There also are not as many either multi-specialty physician groups that have organized outside of some of the very well-known ones, or at least not available everywhere in the country. And why that is the case is also not clear to me.

So I think we need to begin to think about how we structure virtual systems that allow for people who do not have easy access to these integrated groups to gain from them, and there are some interesting areas that we can look to. One of my experiences over the last 15 years is working as a trustee for the United Mine Workers Health and Retirement Funds. They are providing support to a frail, elderly population that are frequently not in areas where there's much of a medical infrastructure. And they have made use of geriatric case managers, a very proactive involvement to try and go after poly- pharmacy for people who are very heavy users of pharmaceuticals to make sure that they're integrated.

Other strategies to try to mimic some of what happens in an integrated system -- doing virtual groups will be much easier if we can promote the health IT. You've taken now a first step with a push to e-prescribing, little step, but a first step in the bill that was just passed. I think that will -- that's to me ultimately going to allow people maybe to have better insight as to the gaines they could have if they were part of an integrated system.

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