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George Halvorson on health care reform, reforming chronic care

by Matthew Holt

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


  Cody Kuhn wrote @ April 22nd, 2007 at 5:26 pm

“That requires—as Halvorson sorta said but was not too clear about—universal coverage and a massive change in the financing system.”

You have to forgive him for not being too clear. As CEO of one of the biggest HMOs in the country, any change in the financing system could have profound and unpredictable implications for his company. Maybe positive implications…but in a time when healthcare payers really are doing very well, I read the odds as leaning toward the negative implications side.

You have little incentive to change when there’s so much predictable money involved. Throwing more money at those kinds of problems usually just leads to some perverse, worse situation.

  Robert S Hedin wrote @ April 23rd, 2007 at 8:29 am

It’s about time to reveal the real truth. Every EMR slows down the office. That means two imperatives in contradiction:

1. Better documentation results in improved, safer care
2. An encounter averages $64.00 so see more = earn more

This is America; land of fast food, instant gratification and a quarter or a million medical errors every year. If the electric company killed that many annually, the public would be outraged.

But people are manipulated by the pharmaceutical industry, physicians are protected by the AMA and the insurance industry is only about profit to stockholders.

All the talk about EMR and PHR is circus! Unless patients finally get it that whether they live or die is of NO concern to the business of health care, nothing will change.

PHR is the answer… but only for patients who are willing to fight to save their lives. For the rest, Darwin is on the side of the status quo where money is all that matters.

  Louis Cornacchia wrote @ April 23rd, 2007 at 10:54 pm

Doctors care more than you think.
Doctors want a better way - but it hasn’t existed.
We decided to get together and start building one.
Please take a look at our website and let us know your thoughts.

We think that the PHR makes sense when directly coupled to our hybrid EMR/dictation-transcription system.

We think that it is about time for doctors to stand up for their patients and begin building a better way together.
Louis Cornacchia, M.D.

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