Health Care Reform continues to evolve, but we still have work to do.  During my 40+ years in healthcare from nursing in a county hospital to Medical Group Management and senior roles in HMO development with clinical oversight for several health plans started in the eighties, I’ve seen good progress.  Recruiting for health systems provides a much broader view of what’s happening in health systems across the U.S.


Building an integrated health system in the early eighties taught me the business and finance side of healthcare, something never mentioned in nursing school and until recently not taught in medical school either.  We added a PCP to our busy cardiology practice after he suffered a myocardial infarction, had surgery and needed help to get back on his feet.  This outstanding MD beloved by his patients, had a robust solo practice, but like many of his peers, took little interest in the business side of his office.  We managed his practice, hired a physician assistant, and the result:  His patient load increased, his income tripled and work/life balance improved.  I joined MGMA and became a believer in group practice.  Expect solo practice to become a thing of the past.


By 1980, we were a ten physician multi-specialty group.  We embarked on an ambitious program to build the first Health Plan in Nevada.  Insurance rates were increasing 15% annually.  In 1980, employers were desperate for some way to contain health insurance costs. We educated providers who had only worked in a FFS model.  We established the Physician Referral Committee.  They met weekly over lunch to discuss cases and while we didn’t call it that, they were “coordinating care” which helped us to continuously improve outcomes and reduce cost of care. We were the first in Nevada to provide and pay for preventive care, annual physicals, routine mammograms, colonoscopies and more.  That said, this was no picnic.  In the eighties, HMO bashing was the norm. “As Good as It Gets” with Helen Hunt and Jack Nicholson is still one of my favorite movies, but I always cringe when Helen bashes her HMO for denying her son proper care.


Kaiser, Geisinger and many others developed their own models of integrated care where incentives could be aligned for Providers to do the right thing at the right time in the right place. Outcomes are continuously evaluated with a goal to improve overall effectiveness and efficiency; the new kinder, gentler terms that still mean improve quality and reduce cost. Integrated systems work if you take the Triple Aim seriously.


Technology plays a major part in improving healthcare. Thirty years ago, Leland Kaiser predicted that we would have a Mainframe in Kansas housing all our medical data. We would be able to get our diagnosis and treatment from any airport while we traveled by accessing our own data, inputting symptoms and then connecting to a provider for treatment options. It has taken much longer than Leland predicted, but we are making progress.  I predict telemedicine will be a huge growth area over the next decade. Data will be the key to continue to improve outcomes and lower cost of care. All Americans deserve affordable, accountable, accessible healthcare.


To our men and women on the Hill: You have struck down Repeal and Replace once.   Try this:  Revise and Rename.  This is your opportunity to get America’s Healthcare under control.  Please don’t lose the momentum that began with the Affordable Care and HITECH Acts.


When Harry and Nancy struggled to get those last votes, they had to make many compromises. We all knew this was not the final bill. We knew that the bill needed more study and significant fine tuning, particularly with respect to the COSTS associated.  Balancing quality and cost is an ongoing process. To do this, we must collect, share and use the information and data. We must push for Interoperability where all EMR systems can communicate with each other. We must use the best and brightest minds to study and analyze that data to determine Best Practices; what works, what doesn’t work and recognize RESOURCES ARE FINITE.


Payment Reforms must continue.  The doctors who work at Kaiser earn a good living. The doctors we hired in the eighties earned a good living. Fee For Service invites abuse. You don’t have to game the system to be paid fairly if compensation is based on outcomes rather than how many boxes are checked on the charge ticket.   Value Based Compensation will continue to be tested and tried in various formats. We must reform reimbursement to stop healthcare from bankrupting the U.S.


We’ve created a significant financial imbalance by over paying specialists and under paying primary care providers. The result:  A dramatic shortage of PCPs that is growing in lockstep with our aging population.    Part of the solution is Ancillary providers, but we should also recognize the value of the PCP who rather than know everything on how to treat your heart or your kidneys, has the knowledge to look at each patient holistically and coordinate care. In the Building Trades, who makes more money? The General Contractor or the Plumber?  I rest my case…..


We need to take an in-depth look at End of Life Care in this country. Other nations have progressed well beyond the USA in this area. Atul Gwandi’s “Being Mortal” should be required reading upon receiving your Medicare card and for all fourth year medical Students.   Physicians will continue to drive our healthcare.  They are the eyes, ears and heart of any health system.  Gwandi’s book follows the evolution resulting as information became available to anyone with access to the internet. He says that providers must become our health navigators, prepared and willing to assist patients in determining the right course of treatment based on how they want to live out the remainder of their lives.


Hospital Administrators and our Congressmen and women could benefit from reading Clayton Christensen’s “The Innovator’s Prescription, A Disruptive Solution for HealthCare.” His unique look at our healthcare system from his vantage point as a Harvard Business School Professor and a patient who had suffered three life threatening conditions in a short span in his life is on point (for more information, click here ).


Every other industrialized nation has a system of care to take care of the majority of their people.   If you don’t believe me, check out the International Health Academy Trade Study Missions.  They take small groups of healthcare leaders to various countries to study health systems.  I went to Chile where we met with health ministers, visited public hospitals, met with physicians who worked in both the private and public options. Their cost per capita: Under $800 per year per person.  It was eye opening to say the least. Perhaps we could send a contingent from Congress on a Trade Study Mission.  Email me if you’d like to learn more about these interesting trips.   The US could learn a lot from countries who realized long ago that providing basic healthcare to all citizens is cost effective and improves overall health.  Paula@morganconsulting.com


Paula Morgan is the Founder of Morgan Consulting Resources, a healthcare executive search firm celebrating 22 successful years in business.








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