Raymond J. Zastrow
QuadMed President

Raymond J. Zastrow

Raymond J. Zastrow, M.D. is the president of QuadMed, which helps companies develop on-site health care for its employees.

Back To School

If you go strictly by the calendar it wouldn't compute, but summer appears to be over in my corner of America. Wisconsin has been enjoying frankly autumnal weather for the past three weeks. The change in the weather combined with the general sense of let-down regarding the health-care reform legislative process have kept me from blogging for awhile. I truly wish I could get behind the House of Representatives on HR 3200, but they missed the mark, and by a wide margin. So now summer vacation is over and it's time to get back to work -- for me as well as congress.

I was very pleased this past Sunday to note that my friend, Serigraph CEO and Milwaukee JournalSentinel columnist John Torinus again did a really good job of highlighting the major deficiencies in HR 3200 in his weekly column. To paraphrase John in a nutshell: HR 3200 fails to address the $30 trillion unfunded liability for Medicare, fails to allow insurance to be purchased across state lines, fails to deliver pricing transparency, fails to deliver bundled pricing for care episodes, fails to mandate quality reporting and fails to stimulate individual responsibility for staying healthy. My biggest gripe is that the bill fails to address what I believe to be the root cause of the huge difference between what the U.S. spends as a percent of its GDP and the rest of the world, namely the incredible inefficiencies promoted by the piecework payment methodology we use. HR 3200 makes no serious provision for promoting patient-centered primary care which we, at QuadMed, have proven delivers higher quality care at lower cost. Nor does the bill provide any impetus to apply lean transformation principles to health care.

So, as I contemplate the topic of how, politically speaking, the Obama White House can get meaningful health-care reform legislation back on track, it is with John Torinus' observations freshest in my mind. I go back to a couple of principles I enumerated early on as an invited panelist for the Post: That health-care reform must be a separate issue from health-care delivery transformation. That our current non-system is un-sustainable and that merely deciding to pay more for the same-old-same-old is probably the worst option we face and shouldn't even be on the table.

So here are my recommendations: First, hit the brakes. I believe that people are as upset by the rush to jam through a more than 1000-page bill as they are about its estimated price tag. I learned a very helpful 'mental construct' when I worked in IT, called, "Good-Fast-Cheap." In essence, when rolling out any new project or system, you could have one or at most two out of the three -- but not all three at once. HR 3200 certainly came at us Fast, but it doesn't look too Good and it is certainly not Cheap.

Second, chunk out reform into multiple bills. To some extent, the Senate Finance Committee signaled last spring that it was contemplating reform as an opera in three acts when they published their three white papers. Determine which aspects of reform should be stand-alone legislation and take out the nice-to-have distractions (to be addressed in future legislation). The recent uproar over advance directives, necessary as they are, is a case in point. Here are my major chunks. Problem: 47 million uninsured. Solution: individual mandates, verified on the tax rolls and publicly supported for the impoverished; employer mandates to play-or-pay, with preferential tax treatment for those employers who deliver superior value for their employees. Problem: Inefficient, fragmented, expensive care. Solution: Patient-centered primary care, which leads to overall better outcomes at lower cost. While we're at it, nuke the toxic Current Procedural Terminology (CPT) piecework payment methodology for chronic care management and replace it with a pleasant mix of capitation, fee-for-service and just a gentle sprinkling of pay-for-performance. Address the deficiencies noted in paragraph 2 above. Insurance reform as a separate bill. Wellness incentives as a separate bill (Sen. Enzi, anyone)? Tort reform must be addressed, but again, as a separate bill.

Third, strive for bipartisan solutions. 'Nuff said.

As the August congressional recess comes to an end, it should be "back to school" time for our elected officials in Washington. Time to put the summer behind, hit the books and focus a little "remedial education" on creating a sustainable model of health-care financing that doesn't bankrupt employers and which doesn't keep shoving under-funded health-care liabilities onto our children to pay for later.

By Raymond J. Zastrow  |  September 2, 2009; 5:36 PM ET  | Category:  Health Care Reform , Health costs , Individual mandate , Insurance Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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