We need organized delivery systems – health care

We need organized delivery systems – health care – column

Martha L. Thornton

We need organized delivery systems Increasing access to medical care through increased access to medical coverage is a goal the business community supports, recognizing that, at least in the short term, this goal will require increased public and private expenditures.

Access must not be dealt with in a vacuum. Additional reimbursement dollars without any cost controls will exacerbate the current cost spiral. Increased access cannot be accomplished independent of changes to the delivery of care, and without regard to the cost and quality of that care.

Cost control and quality improvement must be part of the solution. Cost control is important for us and for all American industry as we compete here and abroad for business. While health care is an expense, it can also be viewed as an investment in our human resources. A productive workforce is important, and effective health care contributes to building this competitive asset.

New approaches, such as organized delivery systems, bring the interested parties together in a cooperative effort. Organized delivery systems are showing that controlling costs is compatible with improving quality of care.

Public policy must encourage the development and use of organized delivery systems, which should be the preferred means to improve access. Large employers are using this approach for their employees, including senior management. We are not advocating something for others that we are not willing to do ourselves.

The success of organized delivery systems, and cost control in general, will depend on a body of knowledge about the effectiveness of various medical interventions, or the lack thereof. Increased government support of research in this area will be critical.

The role of government

The federal government must set the parameters and ground rules within which we operate:

* We need laws encouraging utilization review, selective contracting arrangements, and other managed care approaches which will help the development of organized delivery systems.

* Government should not micro-manage the health care delivery system or the benefits delivery system, except to protect the health and safety of the public.

* Government must continue to be the safety net for those without the financial means to access health care. In addition, it should remain the primary payer for the elderly through the Medicare program. We support the use of private health plans as the vehicle to expand coverage, and therefore access.

* Government programs should be financed appropriately. Financing should be explicit and widely based. Use of taxes or surcharges on those with medical plans, such as premium taxes or taxes on medical services, should be eliminated. This includes use of “all-payer” systems that place surcharges on hospital or physician bills for uncompensated care.

* Government must purchase health care, such as is done by the private sector. It should not shift its financial responsibilities to the private sector, nor should it use its legislative powers systematically to underpay providers.

* The federal government should increase its support of the evaluation of new and existing medical technologies. Technology evaluation includes development of practice guidelines or parameters.

* Goverment support for technology evaluation studies can help determine which technologies would be disseminated to the community, as well as which would be withdrawn.

* The government can help develop treatment guidelines for needed reform of the medical malpractice system.

Initiatives could also include projects like the planned trial of the outcomes management tools championed by Paul Ellwood. The trial is being conducted by a consortium of large national managed care firms and national employers, including Ameritech. This project will evaluate the effects of medical interventions by measuring the changes in a patient’s ability to carry out his or her normal daily activities. From this, we will be able to determine whether the intervention improved, maintained, or decreased the patient’s quality of life.

Martha L. Thornton is senior vice president, Human Resources, Ameritech, Chicago. The article is adapted from testimony presented to the U.S. Senate Committee on Labor and Human Resources.

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