Stakeholders share input

The Mission: Incorporate wisdom from Colorado health care stakeholders
Introduction
Stakeholders identify problems with current health care system
Stakeholders suggest ways to improve the health care system
Stakeholders share thoughts on health care funding
Stakeholders wary of changes affecting health care systems in big ways

Introduction

In November 2012, the Colorado Foundation For Universal Health Care launched the Stakeholder Input Project (SIP) to assess what influential people in Colorado health care were thinking about the current health care system.
The Foundation’s intent was to provide a picture of health care in Colorado – a picture to be shared with legislators and interested parties. A small team from the Colorado Foundation for Universal Health Care reviewed and aggregated stakeholder insights and comments, and then presented them to assist State Sen. Irene Aguilar, M.D. and her team as they crafted a draft of a bill forming a Colorado Health Care Cooperative—a bill Sen. Aguilar plans to introduce this year.
As a follow-up to the SIP project, on Dec. 19, 2012 Sen. Aguilar invited 150 important health care stakeholders to attend a meeting at the Colorado State Capitol. She introduced the draft legislation and held an open forum. Those who attended brought up many excellent questions and comments. At that time the advocacy group Co-operate Colorado initiated the Legislation Preview Project (LPP). At the end the meeting, the draft of the bill was posted online at Co-operate Colorado’s website at www.health careforallforless.org so that Colorado stakeholders could preview and submit comments on it.
We are immensely grateful to the following people who participated in the initial in-depth SIP interviews and gave so generously of their insight. They approach health care from different perspectives that include patient advocacy, business, health care policy, legislative policy, and providing and administrating health care. They participated not because they align themselves with the Colorado Health Care Cooperative, but rather to be part of the discussion. They wanted to give voice to the unique understandings they have gained based on their experiences and involvement in health care in our state.

1.  Elisabeth Arenales, Colorado Center on Law and Policy
2.  Jennifer Dingman, PULSE Preventable Deaths Due to Medical Errors
3.  Joan Henneberry, Health Management Associates, former Director of Medicaid
4.  Val Purser, South Metro Health Alliance, Director of Community Mobilization
5.  Julie Reiskin, Executive Director of Colorado Cross-Disability Coalition
6. Drew Schwartz, Business Owner, Colorado Plastics
7. Edie Sonn, Vice President of Strategic Initiatives, CIVIC Center for Improving Value in Health Care
8. Julissa Soto, Director of the Hispanic Initiative, American Diabetes Association
9. Barbara Yondorf, President, Colorado Consumer Health Initiative

The Patient Protection and Affordable Care Act (PPACA), signed by President Obama in 2010 won’t be fully in effect until 2014. People are discovering and grappling with the changes and opportunities that the PPACA will bring.
The input we recorded about the state of thinking on health care in Colorado at this critical transition time provides a valuable snapshot of Colorado health care.
Thanks also go to the volunteers and contributors from Co-operate Colorado and the Colorado Foundation for Universal Health Care who made this successful project possible.
All stakeholder feedback came in response to the questions: In an ideal world what would health care look like from your professional perspective? What would it look like from your personal perspective? The summary below is aggregated, meaning that any given point in the summary may come from one or several people, but not from all. There was no attempt to influence the participants or gain consensus.

~Emilie Parker, MS, SIP Project Manager
(303) 317-4558 or emilie.v.parker@gmail.com

Stakeholders identify problems with current health care system

When we asked participants what an ideal health care system would look like, many cited problems with the current system. Even when our system is providing medical treatment adequately, they said, the system itself is causing a lot of other problems for health care providers in it and the patients using it.

• There is a culture of health care scarcity that impacts children, the self-employed and those who have lost their jobs and/or insurance coverage, and those that don’t know how or can’t access the current system.
• Functional care for the sickest individuals in our system, who often cannot work, is not adequately coordinated or covered. There often exists a punitive attitude toward benefits for the very sick or disabled. That attitude causes needed benefits to be denied, delayed, or not covered. There is a pervasive attitude in current benefit design that sick people should not benefit too much from care.
• Disconnected, fragmented systems cause harm and expense. Care that’s needed at early stages of illness (especially for the disabled) is too often not covered properly, leading to expensive hospitalizations or incapacity later. Complex, fragmented systems leave no way to self-correct and render sick people without help or unable to take advantage of better, lower-cost remedies.
• A lack of standards of care causes medical harm and difficulties in assessing and correcting problems.
•  In order to access health care, people currently need a job, some flexible time, transportation, the ability to communicate, and sufficient resources. Sick people do not always have these.
• Health care benefits burden businesses and don’t fully meet their needs. Small businesses have competitive disadvantages as purchasers of health insurance. Employers lose good employees when they get sick and can’t work for a time. There is no safety net.
• Problematic payment structures, models and codes cause harmful focus on delivery of billable services exclusively. Sometimes the billable treatment is not the best fit, the best quality or the most efficient. Sometimes providers know the treatment won’t help. Incentives for unnecessary testing are harming patients. An oversupply of health care services such as MRI causes overuse. MRIs are harmful when used on children.
• Health care provider culture needs to change in cases of medical harm. The culture is guided too often by fear, protecting the guilty and punishing the victim.
• The health care delivery system needs to redefine fair compensation. Health care provider roles and compensation need to be reassessed, better integrated and redefined.

Stakeholders suggest ways to improve the health care system

Quite a few of the interviewees said that the health care system should address the needs of the whole person. Several people described medical homes as a way to improve the delivery of medical care. Medical homes integrate care from a wide range of disciplines and providers in a coordinated way in order to positively impact patients’ health. Medical homes would include health care professionals and non health care professionals such as social workers, family members, nutritionists, caregivers, and others as part of community-based solutions. Diabetes is a disease that responds well to a therapeutic lifestyle. The whole person treatment found at medical homes would benefit patients with diabetes and others.

Several stakeholders suggested that better, more consistent standards of care would improve the health care system. Lack of standards in some situations cause harm and poor outcomes. In many situations, lack of clear standards makes impossible any legal action for victims of medical mistakes. “No-Fault” medical harm would help in TORT reform and patient safety. No-Fault means the payer takes responsibility for people who are the victims of medical harm, regardless of who (if anyone) is at fault. In the current system, victims are too often abandoned to pay out-of-pocket for their ongoing care resulting from medical mistakes because no one can be legally charged. A tiny percent of laws A tiny percent of lawsuits relative to medical harm are ever won. Victims of medical harm often lose their insurance and can’t work, and sometimes must deplete their personal assets including losing their homes before they become eligible for federal aid.

Stakeholders share thoughts on health care funding

Several participants voiced concern about how health care is funded. They discussed issues from how the Affordable Care Act (ACA) will impact funding to how likely the public is to support health care for all. Here are a few of the highlights:

• ACA has provisions to try to hold insurance companies accountable for better care.
• Insurance companies may experience corporate culture changes in order to work within ACA.
• Just like now, health care in the future is expected to include a mix of government,
  business and individual funding.
• Although the insurance industry has a major role in ACA, several stakeholders expressed the
  possibility that in the future the role of insurance companies could be much less.
• Several interviewees suggested that there is growing support for cooperatives, especially because the general public is naturally more favorable to a non-profit approach in health care. The profit motive is generally a concern for patients because of the fear that profit-related motivation affects their care and treatment.
• Some think that there is a wave of support growing for universal health care and for a cooperative. Others think that legislators, patients, and health care providers are not ready to vote for the concept of cost shifting or for using more funds for the common good.
• Several people mentioned that there is a strong sentiment in the public of not wanting to pay for other people’s health care.
• To the public a large risk pool is a more acceptable concept than cost shifting.
• Historically single payer systems and cooperatives have been tried elsewhere and have not always been as successful as expected. One lesson is that a careful assessment and control of risk profiles would be a crucial part of their success in the future.
• Several interviewees felt that  prospective payment systems improve health care overall because they create incentives to keep people well. The focus on prevention and on treating patients early to potentially avoid more complex and costly treatment later is beneficial.
• Benefit packages could be designed to offer incentives for lower-cost treatment options where appropriate.

Stakeholders wary of changes affecting health care systems in big ways

Stakeholders had much to say about the changes that are coming in health care. The size and diversity of the health care market make it difficult to predict how any health care delivery system change will affect diverse parts of the system. For example, changes affecting hospitals also affect doctors, clinics, suppliers, and patients. Therefore, some said, changes need to be implemented in a way that does not overstress the system in unpredictable ways.

The ACA is expected to provide health care for more people. Stakeholders asked: How can we make sure everyone has access to care without overburdening the system?

There are anticipated problems and questions related to Coloradans’ wide variety of health care needs and personal health values. For example, how should end-of-life care by handled? The question then becomes how to handle issues when there is no consensus or awareness of what people value. Values come into play when a system has to decide what to cover. Would everything be covered?

Several interviewees stated that different personal and group health care values need to be considered when deciding what to cover. These need to be observed, researched, known and defined. They need to be integrated into systems.

 

 

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