Kaiser Permanente CEO George Halvorson says that health care reform should concentrate on health care reform—not financing reform. Which means concentrating on the five chronic care conditions–diabetes, asthma, depression, CHF, CAD (heart disease) which count for 2/3 of the money in the 75% of health care costs which go on chronic disease.

Right care for diabetics is delivered right about 8% of the time. That’s not good enough, and a great opportunity to improve outcomes and lower costs. We should be able to get it to being right 80% of the time. And then we can go further and reduce the number of people who get diabetes, by getting at exercise and other issues.

So we need better care for people with diabetes, as this is the biggest section of dollars and the easiest set of solutions. Then move onto the next 4 big diseases.

So we need 1) Focus and 2) Tools.

Tools—we need information and linkages between caregivers. The EMR is the best approach, but for those who can’t get there we need to get to the PHR (personal health record) from payers. The new single provider identifier will allow us to create a semi-electronic medical record—it’s relatively current and electronically accessible.

Then add the PHR to a disease registry and the registry creates follow up for the physicians (and supporters). We need registries everywhere to include the 3% of people who generate most of the cost.

We also need a culture of health—no trans fats, reduce saturated fats, increase activity level.

Also need universal coverage and doesn’t have to be the Canadian model. He feels that Europe does it in other ways, and the debate focuses on administrative costs. But the money to be saved is in the chronic care of those few people, which vastly exceeds the cost of administration.

We need to figure out how to better care, not change the financing system.

Matthew’s comments—Well of course he’s right about where the money is. But the problem is that the incentives in the current system caused by the current financing system drive excessive, inefficient cost of the chronically ill. But it won’t work to tell providers to change that without giving them the incentives to make the change. That requires—as Halvorson sorta said but was not too clear about—universal coverage and a massive change in the financing system. And this is all eerily familiar of the Porter conversation held over at THCB and in the comments about their article at Health Affairs…