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Dr. James Weinstein, CEO of Dartmouth-Hitchcock

What he should say

Healthcare leaders offer suggestions for State of the Union

By Modern Healthcare
Posted: February 9, 2013 - 12:01 am ET

Modern Healthcare reporters reached out by phone and e-mail to leaders from across the industry to find out what they hoped to hear from President Barack Obama on Tuesday. Here's what they said:

Dr. James Weinstein, president and CEO of the Dartmouth-Hitchcock health system

“The president now needs to call on the people. Until they are engaged, we won't have the disruptive change that we need and innovation to drive that change to achieve what we call a high-value sustainable health system. To do that, the president should call on groups like the High Value Collaborative that's run out of Dartmouth-Hitchcock.

It's time to move away from policymaking into practice-making and implement the strategies for real change that will create a sustainable health system, not a healthcare system, for America. The question is: Will he say anything? You would hope that he would, given that that was the major issue he started his presidency with. I would hope that he would come back and say: We had some historic legislation, there's work to be done to implement that legislation and it will require all Americans' attention, innovation and spirit to change it.

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We have to set the challenge. Before the end of this decade, America should have a value-based healthcare system that's transparently measured and people can judge healthcare as well as they can judge what's in a cereal box. Today, we can't.”

Dr. Eric Topol, chief academic officer at Scripps Health, San Diego, and director of the Scripps Translational Science Institute

“The most exciting, innovative dimension of medicine—our ability to digitize human beings (via sequencing, sensors and other tools) and practice precision medicine—will not even be mentioned. It's not on the radar screen of U.S. healthcare policy today.”

Marna Borgstrom, president and CEO of the Yale New Haven (Conn.) Health System and CEO of Yale-New Haven Hospital

“Broadly, what I would like to see him address around healthcare is not just how to cut healthcare costs to, quote, make it more affordable, but how to really step back and think about what kind of care we want, how we want people to have it and who we want to insure. …

What the debate seems to have been about a lot more in the last couple of years is we've got to cut a little bit more, we've got to cut a little bit more, but without regard to who we're covering and what kind of care and access we want them to have. …

Marna Borgstrom, CEO of Yale New Haven Health System
We shouldn't just be talking about what we can pay for healthcare, we ought to be talking about how we relate that to helping to evolve a more rational healthcare delivery system. … We have a projected shortage of physicians. So at a time when we've got the state and federal government insuring more and more people, we don't have a corollary plan that says, how are we going to make sure that there are enough physicians ... PAs (physician assistants) ... nurse practitioners? And education generally doesn't pay for itself. It doesn't operate in a market where supply and demand work. When you leave it to that, you get the wrong distribution, wrong mix of providers.”

Joseph Antos, scholar in healthcare and retirement policy at the conservative American Enterprise Institute

“President Obama should level with the American people about the real problems we face in healthcare and how we can work together to solve them. It is time to move to a health system that is responsive to consumers and that lives within its means.

Instead of advancing another round of fee cuts that will never be implemented, change the incentives that drive Medicare spending and give seniors a choice of plans that compete on an even basis. Let states do a better job of operating their Medicaid programs by giving them full flexibility rather than requiring them to seek waivers for even small changes. Give states that accept that flexibility a predictable federal subsidy based on the number of people served, not the volume of services provided. Introduce a more realistic understanding of what it takes to implement the Affordable Care Act.

Joseph Antos, healthcare scholar
At least 20 states will not create a state insurance exchange, and most of the others face great difficulties in making it work. They need more time, and so does the federal government. A delay, allowing states to move at their own pace, is the only responsible action—but one that will be especially difficult for this president.”

David Kendall, senior fellow for health and fiscal policy at Third Way, a centrist Democratic think tank

“Eliminating wasteful healthcare is critical to the nation's economic security. President Obama can take some of the credit for the recent slowdown in Medicare spending due to the Affordable Care Act. He should also say, however, that now is the time to lock in that lower growth rate by eliminating wasteful healthcare.

It may take 30 years to eliminate the 30% of healthcare spending that does nothing to improve patients' health. But the effort will be well worth it because it will avoid two awful alternatives: crippling tax increases on the middle class and major cuts to social insurance programs. Everyone involved in the healthcare sector will have to change their behavior to cut the waste. Patients at risk for diabetes will have to improve their diet and exercise. Doctors who practice independently will have to work as teams to improve care and lower costs. Health plans will have to support all health professionals with new payment systems that reward high-quality care, not the quantity of care.

For all that to change, the next step must be bipartisan. Otherwise, the task of cutting the waste will be a victim of the political process, not its goal.”

Robert Henkel, CEO of Ascension Health
Robert Henkel, president and CEO of Ascension Health, St. Louis

“We hope the president highlights the enormous difference his Affordable Care Act has already made in the lives of millions of Americans who no longer worry about pre-existing conditions or losing coverage after leaving college.

We hope that he remains committed to addressing and resolving the continuing concerns around religious freedom as we expand access to insurance. We hope he urges states to acknowledge their special obligation to provide peace of mind to millions of our low-income citizens by expanding the Medicaid program, which cares for those who are poor and vulnerable.

We also hope the president acknowledges that universal access to affordable health insurance is possible only if we continue the hard work of transforming our healthcare delivery system, to reward doctors, hospitals, and nurses when they keep people healthy as well as when they help people heal.

Finally, we hope the president references the first lady's initiative to encourage healthy foods and healthy lifestyles, and reinforces the role of personal responsibility in a transformed healthcare system.”

Helen Darling, president, National Business Group on Health
Helen Darling, president of the National Business Group on Health

“What we would like to do is have him say what essentially would probably be no more than two or three sentences, but would focus on the really important ways that improvements can be made in quality and safety and affordability and not through blunt cuts but through building on programs—many of which are already authorized under the Affordable Care Act—and all of the steps that many hospitals and healthcare systems are now taking to, for example, reduce preventable readmissions and reduce healthcare associated conditions. …

Those are some of the ways that healthcare systems can really make a big difference. And what would be ideal is if he would then cite one or more of them to demonstrate that this isn't just theory; it's practice. I mean, there are healthcare systems, a number of which are award-winning, and he could mention one in every region of the country—like Memorial Hermann down in Houston, Virginia Mason in Seattle and the Geisinger system in Pennsylvania. I could go on and on. Henry Ford in Detroit.

And by saying we're going to deal with the problem of the national debt and the deficit by reducing healthcare costs, but we're going to do it in the right way, not in the wrong way, and it's in everybody's interest. We all contributed to the problem, so we all have to pull together.”

Mark Pauly, professor of healthcare management, business economics and public policy at the University of Pennsylvania's Wharton School

Mark Pauly, professor of healthcare management, Wharton School
“There are things I'd like him to address—the odds of it happening are pretty slim. He's already given the State of the Union lite in his inaugural address, and his comment about healthcare there was we are going to control costs and maintain quality in Medicare. There's a number of things in the health reform bill that might work.

There, in my view, almost none of them have very good research support. I just hope the president will be more concrete, I guess to put it in a positive way, about something that we have reason to believe that it will work as opposed to cheerleading for things that some people support, but which the evidence base is really not there. Like preventive care is going to save money, and things like that. I hope that he doesn't talk about that, although I suspect he will. … I hope he'll propose something to control Medicare spending that really is large- scale and actually address the problem as opposed to nibble around the edges.”

Mike Kasper, CEO of DuPage Medical Group, Downers Grove, Ill.

“We would like to hear President Obama reference and confirm the key role physicians play in the delivery system and improvement of healthcare. Most of the ideas and rhetoric thus far have been hospital-centric, favoring an employment model as the answer for revitalizing healthcare.”

Richard Pollack, executive VP, AHA
Richard Pollack, executive vice president of the American Hospital Association

“We hope to hear about the president's commitment to make meaningful improvements to entitlement programs through changes to the delivery system, not through indiscriminate cuts to payments for hospital services. Regulatory action is needed to break down the barriers that impede the care coordination between physicians and hospitals.

We hope he can offer policies that streamline and augment the ability of physicians and hospitals to coordinate and improve patient care. We want to hear him address the need to carefully calibrate the reductions in the ACA to hospitals that serve higher number of uninsured patients with the phase-in of the newly insured. We would welcome his acknowledgement that hospitals need adequate resources to support their mission to serve patients and communities.

And finally we hope that he recognizes that hospitals have managed to hold costs down by keeping healthcare spending growth at historically low levels for the third straight year. This was done by reducing infections through initiatives that enabled hospitals to make improvements that are good for patients and help to bend the cost curve.”

Robert Town, professor, Wharton School
Robert Town, associate professor of healthcare management at the University of Pennsylvania's Wharton School

“I think the next challenge, assuming the challenge of coverage has been mostly solved with healthcare reform, is going to be costs and how do we contain costs, yet not lose both the quality of care and, at least at the high end, that doesn't

get diminished and we're able to maintain a level of technological improvement.

Now maybe that's 'tastes great and less filling' at the same time and maybe not possible. But I think that's kind of the real challenge going forward. … There are a number of ways to deal with it. You could deal with it as part of tax reform and do something radical, but (something) I think most economists would like to see, which would be the repeal of the pre-tax benefit health insurance.

The pre-tax benefit serves as subsidy for health insurance and probably a distortionary subsidy. It subsidizes people to purchase too much of it and may have too generous of plans and that causes prices to be too high, it kind of ripples through the whole healthcare economy. And by doing so, at the same time, you would raise quite a bit of revenue. It kind of addresses two issues.”

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Dr. Kurt Newman, president and CEO of Children's National Medical Center, Washington

“We applaud the president's focus on mental health in his response to the Newtown tragedy. At Children's National, we emphasize that mental health is best understood as a lifetime issue that begins in childhood. … To identify mental health issues earlier, we need to train entire communities of first responders.

In addition to training emergency medical services personnel, we also need to train teachers, coaches, daycare workers, bus drivers and others in the community who are with children and teens every day. These first responders need training to recognize, identify and intervene to get these kids access to care.

We have the technology, the research and the infrastructure needed to address mental health issues early, before they limit the lives of our children and teens. We must come together now as a nation to commit to this work.”

Donald Fisher, president and CEO of the American Medical Group Association

“AMGA hopes that President Obama will discuss the urgent need to reward physicians for quality of care, rather than for quantity of care. AMGA has been advocating for the creation of a separate category or bucket for high-performing health systems within the sustainable growth-rate formula, more commonly known as the SGR.

Under the proposal, high-performing health systems would be rewarded for successfully managing the per capita cost of healthcare, improving the overall patient experience and improving the health of respective populations.

These systems would be required to demonstrate activities that improve patient care: an organized system of care; quality measurement and improvement activities; care-coordination activities; the use of information technology and evidence-based medicine; efficient provision of services; accountability; and compensation practices that promote these objectives.”

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