I was cautiously optimistic about the conversation that the nation was having earlier this year regarding our need to drastically reform our health system. The stakeholders - government, insurers, physicians, hospitals, employers and the population were willing, able and engaged in the effort. The President set forth eight pillars fundamental to health reform and challenged the health system to embrace the necessity of change.

The thing that concerns me about the current health reform discussion is that the debate has once again boomeranged back to a focus on payment reform, not true health reform.

President Obama’s position for health reform has been closely aligned to the nation’s economic health. His argument: healthcare costs consume about 18% of our GDP and until we get health care costs under control our nation’s economic health is greatly impacted.

A recent study by The Robert Wood Johnson Foundation extends the argument beyond health reform and has examined the impact that job loss has on health conditions. The key findings in the study include:

- The likelihood of individuals who lost a job through workplace closure reporting fair or poor health increased by 54%.
- The odds of developing a new health condition rose by 83% among those who had no preexisting health problems.
- Even when individuals found new jobs, they continued to have an increased risk of new stress-related health problems.

David Williams, staff director of the Robert Wood Johnson Foundation added this thought. “Where and how we live, work, learn and play have a greater impact on how healthy we are than the healthcare we receive.” I am not sure that I agree with Mr. Williams completely but I think there is definitely merit to his point. Beyond looking at health reform as the delivery system and a cost containment effort, we also must examine how other environmental factors contribute to our health and therefore, contribute to costs.

I don’t know about you but I continue to be amazed at the on-going dialog that is taking shape between the government and key influencers within the healthcare market. On Monday, President Obama met with health care providers to continue ongoing discussions regarding cost containment and universal coverage.

Do I think that hospitals, health insurers and pharma companies are acting in such a conciliatory manner in order to have more say in the health reform bill that will be introduced later this summer? Sure I do. However, optimist that I am, I also believe that there is a recognition from all parties that the system is failing the people and that at its current trajectory the system becomes unsustainable. Everyone, health insurers, physicians, hospitals, pharmacies, pharma companies and individuals will have to accept trade-offs if health reform is going to be successful. While I continue to think that this administration has taken the health reform discussion further than any previous administrations, the proof will be vetted out in action. What are your thoughts on Monday’s discussion?

To date much of the discussion around health reform has been focused on cost containment, IT and the delivery system but little has been mentioned about a key pillar in President Obama’s health reform initiative, the pillar of wellness and prevention. Today, wellness and prevention took front and center stage in the dialog that President Obama continues to have with the public, employers and other stakeholders regarding the national imperative for health reform.

What does President Obama’s announcement mean for preventive health? Like much of the initial dialog around health reform, I think that this is the beginning of reframing the discussion around individual accountability and the health system’s responsibility to lead the effort in educating and motivating critical behavior change. If the goal of the health reform effort is ultimately to bend the cost curve, through efficiency and inclusion of all into a system the root cause of cost escalation needs to be addressed. While I may be oversimplifying this, evidence continues to mount that individual health habits and behaviors are associated with a significant portion of preventable healthcare conditions and now is the time to address a root cause of healthcare costs - change health behaviors.

What I found interesting today is that employers who have successfully managed to contain their healthcare costs such as Pitney Bowes, Safeway and J&J have done so through effectively building an integrated wellness culture. In addition to experimenting with various benefit coverage and designs, these organizations actively talk, treat and reward their employess for personal health accountability. The organizations that President Obama mentioned today have some other fundamental elements that are critical to their success in developing a wellness culture. Their program elements are integrated, tied to a performance culture and include the recognition that incentives, rewards and continuous awareness and dialog with their employees enables the emotional connectivity that ultimately leads to individual engagement. These companies have proven that it is possible to lower costs through a focused effort on health and wellness. These companies have proven that an integrated health and wellness solution that truly engages individuals ultimately leads to increased productivity and a return on investment. Isn’t it time that we all begin to take a page from their playbook?

Reuters published an article regarding the growing support for a mandate for health insurance as part of the reform effort that are currently being debated. There are 46 million individuals uninsured in this country, the majority have no coverage because they simply can’t afford it. This is an interesting debate to me for several reasons:

- These uninsured individuals usually wait until absolutely necessary (read: really really really sick) before they utilize health services and usually the point of entry into the system is the ER…the most expensive entry point.
- The costs to care for this uninsured population is already being transferred to employers, individuals and the govenment.
- Providing some type of coverage seems to make sense if enables the system to provide more preventive care, thereby reducing the costs of entry.
- Providing some type of coverage should result in less cost shifting to other payers in the system.
- There will and should be trade-offs for providing coverage and health plans need to ensure that the coverage is reasonable and affordable.

Employers are certainly feeling the burden of cost of care for not only their employees but assuming the cost shifting that takes place for care of the un and under-insured. The only way that we are going to truly reduce healthcare costs is if we understand the root causes of what drives those costs up. One of those root causes is the massive number of people who are uninsured. They pay the price in terms of poor healthcare but we all pay the price when it comes time to pay the bill.

There was an interesting article in Health Leaders entitled A New Kind of Growth Strategy and it focused on the three strategies that hospital CEOs are taking to drive revenue growth:

- expanding outpatient services
- focusing on promising business lines
- implementing a strategic marketing campaign

Carrie Vaughan raises an interesting point regarding the fact that hospitals seem caught up in the mentality that they have to continue to be big buildings where people come when they are sick. Given the focus on prevention and wellness, I wonder if this isn’t a question that all healthcare entities should be considering - How do I change to deliver on prevention? How does my revenue growth model change to deliver on value? How do I envision my future services?

The complexity of our health system not withstanding, I try to look at the problems in healthcare more simplistically - what are root cause issues for a system that is essentially backwards. Healthcare providers ultimately develop their strategy based on how to achieve the highest amount of reimbursement. So wouldn’t it behoove us as a healthcare system to figure out a more compelling reimbursement strategy that promotes more strategic initiatives around prevention. Wouldn’t accomplishing this task open up the opportunities for hospitals, physicians, pharmacists and even pharma to begin to focus their strategies on innovative prevention methods and services? I know it won’t be easy, it never is but it is my thought for the day.

A recent article in the Chicago Tribune entitled Health Care Reform Talk Goes Local covers one of the many community discussions on health reform that took place over the holidays. One individual summarized the issues facing the health care system in four words: access, quality, cost and prevention while other schools of thought challenged whether the United States actually has a system. The turnout was large and well represented by actual providers of health services as well as consumers.

What I found interesting in reading this article is that there still seems to be a perception that universal coverage and socialized medicine are one in the same. It was also interesting to note that wide ranging perspectives on a market based system. While there was a wide range of opinions on the topic, a prevailing theme that seems to be taking shape is that our nation cannot continue down the current health care path. Change needs to happen and after reading multiple articles on the community sponsored health care reform discussions, I believe there is no doubt that the movement for health care reform has begun. Whether it ends with a decisively different system is anybody’s guess.

I just finished reading Senator Tom Daschelle’s book, Critical - What We Can Do About the Healthcare Crisis. It is a relatively easy read and provides a pretty clear deconstruction about how our health care system has gotten to this point of crisis. He also spends some time articulating a new model that is still based on free markets but with a more robust framework that closely parallels the Federal Reserve Board framework for our financial system. It is an interesting line of thinking and for those of us who work in the health care market, the book provides some interesting insight as to what the future Health and Human Services Secretary may be planning.

On Friday, December 5, the Obama/Biden Transition Team opened up an invitation on www.changegov.com (Join the Discussion:Healthcare) for the nation to participate on a discussion focused on the policy and reform efforts that need to be tackled in order to fix our health system.

Whether true reform results from the efforts to build and strengthen strong public support is yet to be seen, but when was the last time we saw the government seek to incorporate such broad perspectives on such a critical topic. While I do not think that the conversation will reveal anything that we didn’t already know, in terms of fundamental pillars of reforming the health system, these types of outreach efforts may actually “humanize” the process and lend voice to the massive up hill climb our nation has in fixing a broken system.

What I find particularly fascinating with this initiative is that Tom Dschle and company recognize the failure points that doomed past healthcare reform initiatives – the lack public mobilization. While Tom Daschle’s blueprint for health has many similarities to the Clinton health reform blueprint from the early 90’s, it may be that his success or failure in winning the battle for a revamped health system may depend on how effectively a national discussion on health occurs and how engaged the public is behind his referendum for change to the health system.