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July 5, 2005

A Revolution in the Health Care Industry

Richard B. Weldon Jr.

It's somehow fitting, me writing a column on a revolution on the 4th of July. It isn't as though I was struck with a flash of inspiration thinking about those early patriots, though.

I've actually been thinking about this particular revolution since my days as the city administrator in Brunswick. In addition to helping residents solve problems and deal with the political struggles of a small town (there were many), one of my most vexing challenges was dealing with the Employee Benefits Program.

The single most expensive benefit, and without a doubt the most complicated management problem, was the annual health insurance benefit negotiation. Keeping 38 workers covered with health benefits occupied a good deal of my time.

There were two components of this problem. First, we were challenged, trying to keep a lid on the annual increases in premium cost. When I started with Brunswick, the mayor and council covered the entire cost of the premium, but, during my tenure, costs were raised so much that we had to "share" the premium with the employees.

Second, instead of a corresponding increase in benefits to match the rising costs, the insurance companies were reducing the range of benefits and covered services. As the insurers tightened up the process for paying claims, doctors began to accept fewer new patients.

So, when a new employee joined the city, and signed up for healthcare, they inevitably opted for Health Maintenance Organization (HMO) coverage. It was substantially cheaper, and, remember, the employees were now subsidizing a share of their monthly premium.

These same HMO's were the ones who were pinching pennies with the doctors, so some employees had real trouble finding a doctor willing to take on new HMO patients.

Even with my limited exposure to the healthcare industry, it was apparent that a real storm was brewing in the future.

Flash forward seven years. Now I find myself serving in the state legislature, and more specifically on the committee that deals with health care issues. I get magazines, web referrals, and legislative information from all over the country dealing with health care issues.

Something has to change. The system has so many problems that both access to and quality of care are becoming major problems. Leaving this solely in the hands of private industry is a recipe of disaster; likewise, asking government to fix it alone would be foolish.

I was energized this past weekend by a visit to Frederick from one of America's leaders in the field of transformational change, former U.S. House of Representatives Speaker Newt Gingrich.

Some of my fellow writers will automatically knee-jerk into a contemptuous sneer, but they'd be wise to hold their reaction.

I'm not here to blow Newt's conservative vision horn, although I find much to agree with him on. No, my inspiration from Newt Gingrich comes from his grasp of the ills of the modern American healthcare system and why we're failing to address the most basic health needs of our citizens.

Ours is a system where long waits, high costs, and poor quality dominate the delivery system. The only reason we haven't seen a revolt is that our system, fraught with flaws, remains the best health care system in the world.

The fixes are already being "field tested" around the country. The Veteran's Administration has already implemented a paperless pharmacy dispensing system, virtually eliminating the transcription errors caused by poor penmanship and lack of attention to detail. Would I shock you if I told you that as many as 98,000 people die each year because of medication mistakes?

The VA hospital system has also instituted an on-line patient tracking system, fully compliant with the Health Information Privacy and Portability Act (HIPPA). This system allows vets to move around the country, and provides easy, data-protected access to their records by doctors, pharmacists, and hospitals.

Touchpoint Health Plan of Appleton, WI, is using ThedaCare to manage a comprehensive diabetes treatment system. Integrated care, from primary through specialty, with bulk purchase agreements for supplies and coordinated treatment information management is reducing costs and increasing access to care.

ActiveHealth Management, Inc., of New York City, has introduced the CareEngine Service, a comprehensive set of evidence-based case management tools for use by the network's doctors and caregivers.

Using these tools, ActiveHealth is anticipating saving between 2% and 4% on Medicaid and Medicare patients. Extrapolating those savings, we could be looking at a $9 billion cost avoidance! While cost savings are very important, the most significant benefit to the CareEngine approach might be the improved care facilitated by doctors who benefit from the matrices that suggest failed diagnoses in certain patients.

These are just a few examples of how innovative, creative solutions to long-standing problems are leading to major improvements in access and quality of care. There are literally thousands of similar examples.

The health of the American public is so important that we need to approach this problem with a fervor and passion not seen since the days of the Revolutionary War.

Just as then, our children's future depends on how hard we fight to improve the system right now!

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