Program That Reduces Healthcare Cost by 15% Responds: Michael Moore's Solution Would Increase Costs, Delays, and Deaths in America
Innovative program reduces healthcare cost by emphasizing coordination of care, communication, and Primary Care Physicians
COLUMBUS, Ohio, June 29 /PRNewswire/ -- As the nation heads to movie theaters this weekend to see Sicko, Michael Moore's expose on U.S. healthcare, the company that operates an innovative healthcare program that has dramatically reduced cost by improving patient assistance says that government-run healthcare would increase, rather than solve, America's healthcare problems.
Randall E. Gebhardt, president of Quantum Health Inc., said that Michael Moore falsely implies that government-run healthcare works well in Canada and the U.K., and that an expansion in the government's already heavy-handed role in U.S. healthcare - Medicare already directly controls 40% of all healthcare dollars and indirectly controls another 50% - would result in more suffering, more deaths, and significantly higher costs over the next 20 years.
"Michael Moore reaches back and dredges up horror stories from the 1980s and 1990s, and there is a definite implication that healthcare would work better if run by the government," said Randall E. Gebhardt, president of Quantum Health.
"If you want to know how government-run healthcare would work, just think back to the last time you stood in line at the post office, or waited on hold for two hours with the IRS or Immigration service to check on the passport application you sent five months ago, or the news coverage you watched of relief efforts after Katrina. Just think, all your healthcare needs could be run this way.
"There are many ills with U.S. healthcare, and we agree with Michael Moore that the insurance carriers are a big part of the problem. But government already runs 40-50% of U.S. healthcare, and that is also a big part of the problem. If this role were expanded, we would see a national disaster that would make Katrina look like a little weekend annoyance," Gebhardt said.
Gebhardt said that, ironically, Moore's movie makes exactly the point it hopes to disprove - the free market system is functioning well in healthcare. HMOs, whose ethics and patient-insensitivity Moore bashes, had a 70% market share in 1995, but have fallen to less than 25% because patients and their employers have rejected them.
"Hey, Michael," Gebhardt said, "thanks for showing us that the free market system works. The horror stories you dredge up from the 1990s were corrected by the market, because employers and patients rejected the control-oriented HMOs that caused those problems.
"If the government had been running healthcare, the market couldn't have voted with their dollars, and bureaucrats in committee rooms would have retained the status quo - while passing more rules to control behavior - and we'd all be covered by HMOs with even more bureaucracy and an even more confusing maze of paperwork.
"Just look at Canada and the U.K. - that's what they have now. That's why millions of patients are currently waiting for treatment there, and thousands of Canadians cross the border to get the care they need, when they need it, in the U.S."
Gebhardt has been interviewed on camera for the upcoming movie Sick and Sicker, being made by filmmaker Logan Darrow Clements to counter the influence of Michael Moore's film (see www.freestarmedia.com).
But while Gebhardt said it would be a national disaster for government to expand its role in running healthcare, he said there is an important role government should play in driving the market to greater efficiency. He outlined several initiatives the government should take:
-- Make discounts on healthcare services illegal. Today, insurance
carriers and PPOs drive the market with "hidden" discounts that distort
market dynamics, because no one knows what is truly being paid for
healthcare services. To pay for these discounts, hospitals and
physicians charge higher prices to those with less healthcare insurance
-- Require the cost of all healthcare services to be posted publicly, the
way prices for products must be clearly marked on supermarket shelves.
Transparency in pricing is crucial to efficient healthcare buying.
-- Require providers to submit regular reports to a national database on
healthcare outcomes, quality and cost. Over five years, this will
create a national database that all buyers can use to make effective
usage and purchasing decisions.
-- Increase financial grants and incentives to medical students choosing
to specialize in the primary care specialties - family medicine,
internal medicine and pediatrics. Statistics clearly show that these
primary care specialties are less popular because they offer lower
income potential and status than interventional sub-specialties. The
lower income is a direct result of policies in the Medicare system,
which devalue the services of primary care physicians and forbid
payment for coordination of care activities such as calling the patient
or other doctors to coordinate care between visits.
Gebhardt said that Quantum Health advocates an approach known as coordinated healthcare, which has proven that the key to better healthcare is increasing coordination of care, through the use of Care Coordinators who inform and guide patients as they navigate a confusing maze of providers, and through a national focus on increasing use of primary care physicians. In 2006, this approach continued a five-year trend of holding cost increases to one-third the national average.
Just as baby boomers are reaching an age when they need coordination of care more than ever due to emergence of chronic conditions, heavy government influence on healthcare has distorted market dynamics and reduced the resources available for long-term health management.
Studies prove that patients who use a primary care physician have 33% lower cost and 10% lower mortality, so the market should naturally favor these physicians because patients will choose them more often and be willing to pay more for their services.
But government influence already stifles market forces. Medicare bureaucrats set lower reimbursement rates for primary care physicians and higher rates for interventional specialties using expensive diagnostics and surgery. This drives virtually all physician reimbursements in the entire country, both public and private. If these rates weren't set by the government, the market would work naturally to increase reimbursements for PCPs, more medical students would go into this type of practice and Americans would be moved toward better health management and less "sick care." Costs and unnecessary deaths would decrease dramatically.
Gebhardt said the coordinated healthcare concept advocated by Quantum Health saved participating employers more than $22 million - nearly 15% of projected expenses - in 2006. This represented $1,296 per employee for its clients, who are mostly self-insured employers with employees located nationwide. These results were achieved without cutting benefits or shifting costs to employees.
Over the past five years, Coordinated Health/Care has held healthcare costs to an average annual trend of 4.5%, against an industry average of 11- 13% for plans that haven't reduced benefits or shifted more cost to employees. Such results led to Coordinated Health/Care being named Most Effective Design for Mid-Sized Employers by Consumer Health World in 2006.
"The most controllable driver of healthcare cost is confusion and lack of coordination in the process of healthcare itself," said Kara J. Trott, founder and CEO of Quantum Health, Inc. "Essentially, healthcare is broken at the patient level, and that's where employer health plans can make the biggest difference by providing patient support systems that help physicians guide their patients through the process."
Trott and Gebhardt, who applied their background as strategy consultants in consumer decision making and behavior, cited a host of research, articles and books - written by physicians themselves - demonstrating how difficult it is for patients to understand and navigate healthcare. This confusion leads not only to delayed diagnosis and treatment, but also to unnecessary delays and duplication that result in 18-20% of unnecessary healthcare costs that can be completely eliminated.
Trott said one study showed that 50% of patients leaving their physician's office were unsure of what they were supposed to do, and another showed that 60% of physicians forgot to tell the patient how long to take medication they prescribed. In research conducted by Quantum Health, patients referred themselves to specialists 41% of the time, and 61% of these self-referrals were to the wrong specialist, resulting in an average of $3,500 in unnecessary diagnostics and 11 months delays in diagnosis and treatment.
"Patient self-navigation and confusion is a huge problem," Trott said. "Employers need to use their health plan and benefit incentives to encourage employees and dependents to use the healthcare system more efficiently. This requires an integrated package of incentives, patient education, hands-on guidance, wellness and disease management programs."
At the heart of Coordinated Health/Care is a staff of customer service and clinical service professionals called "Care Coordinators," who work cooperatively with patients and their physicians to coordinate healthcare activities. They provide information and assistance, directing patients to the most efficient and effective healthcare resources, getting lab results and treatment details to the right place at the right time, and educating patients on how to handle their chronic conditions and costly medications that cause costs to skyrocket and leave patients and their families floundering.
Trott said that, since its inception in 1999, Quantum Health has learned that physicians need and welcome the assistance of Care Coordinators, who guide and follow patient activities between office visits, using the physician's plan of care. "They have 10-12 minutes or less with each patient and have to keep up with 30,000 published clinical trials each year. They don't have staff or time to follow patients once they leave the office or hospital. Unfortunately, reimbursement policies of most health plans, which are driven by Medicare payment policies, don't reimburse physicians for coordinating patient care, so employer health plans need to provide Care Coordinators who assist the process."
Most gratifying for Trott and her team, she says, is the fact that employers utilizing Coordinated Health/Care have maintained health benefits without shifting cost to employees. Since 2000, the percentage of employers providing health insurance for their employees has dropped from 69% to 60% due to escalating cost.
Trott said that 61% of employers who adopted the Coordinated Health/Care concept actually reduced their cost per employee in the first year.
"Healthcare cost is controllable," Trott said, "but in our view, it's not through the 'macro' policies that industry pundits are focusing on, such as consumer-driven accounts or tax policy, and certainly not government management. It's getting down to the human level where healthcare occurs - with patients and physicians. They need help, and employers can do this. The great news is they can reduce cost while helping their employees more."
Quantum Health, based in Columbus, Ohio, operates Coordinated Health/Care programs in employee benefit plans nationwide. To learn more about Quantum Health and Coordinated Health/Care programs, visit www.Quantum-Health.com or contact Jon Staub, Director of Marketing, at 800-257-2038, ext. 142.
First Call Analyst:
Source: Quantum Health, Inc.
CONTACT: For quotes and comments in response to Michael Moore's Sicko,
Randy Gebhardt, +1-614-395-3366 or Kara J. Trott, +1-614-314-4511; or Jon
Staub of Quantum Health, Inc., +1-800-257-2038, ext 142