Local debates may shape health care

WASHINGTON — In Dallas, in Roanoke, Va., and in communities from California to Maine, health care debates are under way that might improve things without waiting for the federal government.

Maybe it’s just the languor of a hot August — or doubts about federal intent — but the national health care overhaul discussion seems to be running out of gas. President Barack Obama talks about “health insurance reform” — a phrase that implies leaving the cost conundrum for another day. Senators discussing the issue on TV Sunday suggested bite-size reforms until the economy recovers.

In Dallas, insurers and hospital administrators, business and civic leaders are aiming for a Sept. 30 North Texas health care summit. Some of those participating in the conversations say interest is coalescing around tackling costs, access and community wellness.

“This type of gathering can help increase the realization that we do have a demand problem in terms of producing too much disease,” said James Greenwood, CEO of Addison-based Concentra, a national occupational health care firm.

Greenwood said much of the chronic illness in Dallas and nationwide stems from “poor behaviors” involving diet, smoking and lack of exercise.

“The more we can get CEOs of Dallas-based companies to appreciate that, the better. They’re the ones more than anyone who can establish a culture of prevention,” he said.

Access as the key

The Dallas Area Interfaith initiative, meanwhile, hopes the Sept. 30 meeting will consider ways to improve access to health care, said initiative volunteer Julie Schaar.

“Access includes a lot of things — affordability, transportability, even prevention — there’s not much access to that in parts of our community,” she said.

The centerpiece of this Dallas discussion is a different approach to paying for health care based on performance rather than volume.

Most doctors and hospitals are paid on a fee-for-service model — payments go up with service. The more treatment a patient gets, the better it is for the provider.

Health care reformers at the Washington-based Brookings Institution and Dartmouth College in New Hampshire are helping Dallas and other communities create a different model called an Accountable Care Organization. Under this approach, everyone involved in caring for a patient shares a single payment that encourages cost efficiency but also rewards better performance.

It’s a sensible-sounding approach, but there’s still a lot of work ahead.

“When I hear people talk pay for performance, boy, that’s easy to say, but hard to administer,” Concentra’s Greenwood said.

Baylor Health Care System and Texas Health Resources are restructuring their hospitals around this approach. Coordinated care requires good medical records so that everyone involved in a patient’s treatment knows what’s going on, and both systems are investing large sums in electronic health records.

Rewarding performance also requires benchmarks that let everyone know how patients are faring. Once the records, the benchmarks and the transparency are in place, insurers — both federal and private — have to be willing to change the way they reimburse.

Carilion Clinic, a health care provider based in Roanoke, Va., with eight hospitals and more than 600 doctors, hopes to set itself up as a pilot accountable care organization next year, with help from Brookings and Dartmouth specialists.

“We understand that rising health care costs are not sustainable, and that provider leadership is essential to reforms that reduce costs, improve efficiency and are accountable for clinical outcomes,” said Edward Murphy, Carilion’s president and CEO.

Cigna HealthCare regional president David Toomey, who is spearheading the Dallas initiative, said the test for success will be evident when all of the players are in the same room next month.

“Actions speak louder than words,” Toomey said. “I appreciate the e-mails I’m getting saying, ’I’m all in.’... We’ll see where we are on Sept. 30.”

X Jim Landers is a columnist for The Dallas Morning News. Distributed by McClatchy-Tribune Information Services.