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 Response Page - Chase  Interview -      


These comments are responses to the questions listed below,
which were generated in regard to the
Jim Chase Interview of
10-26-2012.
 

OVERVIEW

Quality, cost and patient experience are important ways to evaluate health care, according to Jim Chase. He asserts that the health care system is not a good value for most people in the United States. The goals of Minnesota Community Measurement (MNCM) are to give people the right tools and incentives to make good health decisions and to give clinicians information so they can use it to improve quality and cost. Chase argues that the biggest challenges in developing measures to assess quality, cost and patient experience are access to data and the need to stay focused on a few good measures. According to Chase, cost and quality measures could help in making health-care capacity decisions. Minnesota's health-care exchange is planning to use MNCM's measurement tools for quality and he hopes people will soon agree to a standardized cost measure the exchange would be willing to use.

For the complete interview summary see:  http://bit.ly/U9QuG5

Response Summary:  Readers have been asked to rate, on a scale of (0) most disagreement, to (5) neutral, to (10) most agreement, the following points discussed by Jim Chase. Average response ratings shown below are simply the mean of all readers’ zero-to-ten responses to the ideas proposed and should not be considered an accurate reflection of a scientifically structured poll.

1. Consumer awareness will yield better results. (8.0 average response) Consumers will receive better health care, better experience, and better prices, if data on cost, quality and patient satisfaction are widely available in Minnesota.

2. Wrong incentives now in force. (7.4 average response) Unfortunately, perverse incentives are in force today that reward more spending on health care, irrespective of need or results.

3. Quality, cost, experience vary greatly. (7.9 average response) Too many people incorrectly believe that doctors, hospitals and other providers all do a good job. However, often there is great variation in quality, cost and patient experience.

4. Exchange should include provider data. (6.9 average response) Minnesota's health exchange, being established under the federal Affordable Care Act, should enable consumers to pick and choose insurance coverage based on actual cost, quality and patient experience scores of covered providers.

5. Exchange should use MNCM data. (7.3 average response) The state doesn't need to start from scratch. Data from the Minnesota Community Measurement, a non-profit entity with information on 80 percent of Minnesota heath care providers, should be used in the state’s exchange.

6. Provider data on exchange unnecessary. (2.5 average response) Concern over cost, quality and patient experience is misplaced. People can determine by themselves whether their provider is satisfactory. There is no need for the exchange to make available more data on providers.

7. Don't limit care, no matter the cost.  (2.4 average response) It is wrong to attempt to curtail the provision of health care services. Whatever the expense, more health care services will benefit the population.

Response Distribution:

Strongly disagree

Moderately disagree

Neutral

Moderately agree

Strongly agree

Total Responses

1. Consumer awareness will yield better results.

7%

4%

7%

32%

50%

28

2. Wrong incentives now in force.

11%

7%

11%

21%

50%

28

3. Quality, cost, experience vary greatly.

4%

4%

7%

46%

39%

28

4. Exchange should include provider data.

11%

4%

25%

25%

36%

28

5. Exchange should use MNCM data.

11%

0%

14%

32%

43%

28

6. Provider data on exchange unnecessary.

32%

46%

14%

0%

7%

28

7. Don't limit care, no matter the cost.

39%

39%

7%

4%

11%

28

Individual Responses:

R. C. Angevine  (10)  (10)  (7.5)  (10)  (10)  (2.5)  (2.5)

6. Provider data on exchange unnecessary.  I believe users today have a limited capability to determine whether the provider is satisfactory and virtually no capability to determine whether a provider is cost efficient.

Ray Ayotte  (10)  (7.5)  (10)  (10)  (10)  (0)  (0)

Anonymous   (10)  (10)  (7.5)  (10)  (10)  (0)  (0)

Dave Broden  (5)  (2.5)  (5)  (7.5)  (10)  (2.5)  (7.5)

1. Consumer awareness will yield better results. Question should be: is the proposed data system the appropriate place to spend the funds for? Should the funds go to deliver services, not set up a complex data system, the use of [which] system is unknown?

2. Wrong incentives now in force. This seems to be the prevailing theme-- but is it really true or [a] somewhat biased position? No question some tests and techniques are applied that may not be needed but is that situation the cause of high cost or an excuse?

3. Quality, cost, experience vary greatly. Like all professions and all jobs quality varies and can be improved. To make a statement that too many people believe that doctors do a good job is somewhat [like] pointing fingers without fact. Why do we start from the negative? Why not start with [the fact that] health care is doing well but we want to do better. Statements like the question are self-serving for those seeking to build a new data empire.

4. Exchange should include provider data. This will be beneficial for predictable conditions but for serious and terminal conditions or unexpected situations like accidents, cancer, etc., finding the appropriate data and defining a valid metric will be very difficult and those are the conditions that likely drive costs.

5. Exchange should use MNCM data. There state and Feds are seeking to discredit perhaps any work that does not have the ‘done independently’ stamp on the work.

6. Provider data on exchange unnecessary. There should be data but who and how is not clear.

7. Don't limit care, no matter the cost.  Any attempt to curtail the health care should be questioned. However, there needs to [be] attention to cost management etc.

Chris Brazelton  (10)  (10)  (10)  (10)  (7.5)  (0)  (2.5)

5. Exchange should use MNCM data. If the data is good and is comprehensive, it would be a great start.

7. Don't limit care, no matter the cost.  For a system to have transparency, we have to address competing interests of stakeholders.  Malpractice liability, competition, need for profitability of both insurer and health care provider.  If you pay fees for services, you incentivize more services.  If you reward wellness it could have the unintended consequence of punishing the "failure" of illness, you encourage caregivers to stop providing for the chronically ill or run up bills for more expensive tests.  Imagine a doctor in an isolated rural area treating people who might have been exposed to toxic water, land or air.  Remember the Utah land contaminated by nuclear testing? The doctor will score poorly with poor outcomes and high costs due to expensive testing needed through no fault of his/her own.  A successful system somehow has to balance all these issues, and still encourage the patient to make healthy choices.

Anonymous   (7.5)  (5)  (7.5)  (7.5)  (7.5)  (2.5)  (2.5)

David Dillon  (0)  (10)  (10)  (0)  (0)  (10)  (0)

1. Consumer awareness will yield better results. I don't buy [that] consumers care about price if they are not the ones paying.  (We are still stuck with [the practice that] only companies can deduct, so companies pay for the insurance, [and] consumers use whoever is allowed by the plan.  I have never seen how the data on quality can be accurate given the measurement difficulties. (Random different inputs by patient, so outputs on accurate)  I'll believe user experience could be measured but not sure that is important enough to go through the effort.  Consumers can use brand name (e.g., Mayo) for that.  

2. Wrong incentives now in force. The single biggest issue in health care today.  And, unfortunately, not addressed with Obama care.

4. Exchange should include provider data. I bet they will try.  And, there will be lots of fighting about it.  Too late to use the free and zero liability federal exchange.

6. Provider data on exchange unnecessary. Consumers would care if they were paying but they are not.  You could leave the cost data on a golden platter at their front door and they wouldn't care.  Good luck on your lawsuit when someone believes your quality data is wrong.

7. Don't limit care, no matter the cost.  So, some [person] will accidentally answer this question the wrong way from what they intended.  (I have to admit I almost just did that!)  What do we do with the [people] who think there should be unlimited free health care?  Can we ship them all to Cuba for health care?

Don Anderson  (7.5)  (5)  (7.5)  (5)  (7.5)  (5)  (10)

4. Exchange should include provider data. How would it work under employer paid or partially paid health plans? How much choice does the employee have?

Chuck McKinzie  (2.5)  (10)  (7.5)  (5)  (5)  (0)  (0)

1. Consumer awareness will yield better results. Demand for critical/acute health care is inelastic relative to cost, at least from the individual consumer’s point of view.  Quality of care and satisfaction are situationally dependent. The data will be meaningless to the individual consumer in his hour of need. While it may be viewed as paternalistic, the data we collect and look at should feed comparative effectiveness research and ultimately benefit design. It should be collected to inform population/public health polices not to help individuals make very complex choices. Individuals don't need to know who is best and most cost effective as far as spinal fusions as much as they need to know when they really need one in the first place.

2. Wrong incentives now in force. Unfortunately free speech encompasses the right to market health care, marketing which is allowed under the guise of informing the public. But, alas, free speech also includes the right to sell health care to the public. Unfortunately there is more selling than informing in our market place today.

3. Quality, cost, experience vary greatly. Also, too many doctors have been indoctrinated by their sub-specialty guild and have become "true believers”, too willing to buy in for reasons of confirmation bias (and the $200,000 they still owe on their student loans), while ignoring (when it is available) good objective information. Cardiac stents are a case in point. People will continue to believe their providers so long as they, the providers, themselves believe.

4. Exchange should include provider data. Ideally they should be able to, but we are a long, long way from being able to provide that information, and I seriously doubt that that information (real information as to opposed to arbitrary peripheral data) will ever be available in a form that individual consumers can use.  There are probably more variables at play at the point of needing to make an important health care decision than there are in predicting tomorrow’s weather.  

5. Exchange should use MNCM data. I'm a cynic and a skeptic. I don't know enough about who sits on the MNCM board, what their backgrounds, their affiliations, their motivations are to fully trust them. While their funds come from various sources, there is still some concern about who's minding the store and for whom.

6. Provider data on exchange unnecessary. I might buy that a little bit if they were paying for their care, but by and large they aren't.  Yes, let them pick their provider but all efforts should be geared at "benefits" (an effort that the Secretary of HHS failed miserably at and hence thru a lack of will has likely doomed yet another iteration of health reform to failure): goods and services based on population health data, not individual beliefs or demands, and most assuredly not based on which provider is most efficient, most pleasant when providing care they don't need.

7. Don't limit care, no matter the cost.  Utterly and completely wrong.

Ralph Brauer  (5)  (0)  (7.5)  (2.5)  (0)  (2.5)  (10)

1. Consumer awareness will yield better results. Again, another meaningless leadoff statement. Without specifying what these data might be it is hard to know what to make of this. If the Caucus is going to drive change in Minnesota it needs to insist whenever possible on specifics when asking questions like this.

2. Wrong incentives now in force. Actually the data strongly dispute this. The now-infamous WHO study that ranked this country 37th found that reasons for our low ranking including high infant mortality. The Commonwealth Fund 2007 International Health Policy Survey (updated in 2010) found, "Among adults with chronic conditions almost half (45%) with below average incomes in the U.S. reported they went without needed care in the past year because of costs, compared with just 4 percent in the Netherlands.."  It also found the US tanked dead last in health care access.  However, we ranked first in administrative expenses!    We are not spending too much; we are spending it on the wrong parts of the system.

3. Quality, cost, experience vary greatly. This one is also a broad-sweeping statement that just barely passes muster. "Often there is great variation in quality, cost and patient experience." What evidence is there for that, specific studies, etc.?

4. Exchange should include provider data. Minnesota's Exchange, currently being planned by the usual group of inside players, scares the heck out of me. The public will be allowed to come to the table to make a few final decisions after these folks have done their bargaining behind closed doors. Consumers should not have to justify their choice of health care providers or treatments if their choice is backed by a reputable physician. That choice should not have to be "in-network," cost a certain amount, etc. It should be what the patient and his or her physician thinks will be the best treatment option. A good friend in Greater Minnesota was able to go to Seattle for a bone marrow transplant that she would have been prevented from having by a Twin Cities HMO. My Twin Cities HMO tried to prevent me from having treatment at Mayo or the Cleveland Clinic, because it was "out of network" even though they did not offer the treatment--without which I would have died.

5. Exchange should use MNCM data. I think the Caucus walked over an important line on this one. We should not be in the business of endorsing particular for-profit vendors, period.  The vendor will use our answers to this question in their pitch to the state. That is inexcusable. Please do not tabulate answers to this question. It is way out of line. Up to this point the Caucus has advocated for strategies to help change state government. That is what it should continue to do. Let state legislators and officials choose the vendor. That is what bids and contracts are for.

6. Provider data on exchange unnecessary. The state should make data available, but right now it is making the wrong data available to consumers. How, for example, do state HMO's fare on the Commonwealth and WHO questions? Which health care plan has the highest life expectancy?

7. Don't limit care, no matter the cost.  This was the conclusion of both the WHO and Commonwealth studies. This country was not spending enough money or providing universal coverage, on equal access for all patients and on care of chronic illnesses. It is spending too much on administrative expenses, advertising and non-healthcare-related (revenue enhancing) programs. Preliminary plans for the Minnesota Exchange seem to follow this paradigm.

Anonymous   (10)  (10)  (10)  (7.5)  (10)  (2.5)  (0)

1. Consumer awareness will yield better results. Assuming the data is accurate, and there is consensus of that among providers and plans.  MNCM has done a very good job of providing a forum where the community can do so.

5. Exchange should use MNCM data. Yes.  It would be much better to have a trusted entity like MNCM providing the data rather than having the state trying to reinvent the wheel.

7. Don't limit care, no matter the cost.  Health care is only a fraction of what determines health outcomes.  Environment, behavior and genetics are all important.  This is the main reason other countries have much better health scores than we do when they spend far less.  Our health does not necessarily benefit from buying the latest drugs or technology - we would be much better off investing that money in reducing tobacco use or obesity.

Peter Hennessey  (7.5)  (0)  (0)  (0)  (0)  (10)  (10)

1. Consumer awareness will yield better results. Everyone can agree on this in principle. But the devil is in the details. The guest apparently has failed to provide specific examples of precisely what he is talking about -- what data, how is it significant to the patient, how must the patient be educated so he'll understand the data and use it correctly, etc.

2. Wrong incentives now in force. This statement is pure [nonsense] without specific examples.

3. Quality, cost, experience vary greatly. This statement is pure [nonsense] without specific examples.

4. Exchange should include provider data. This statement is pure [nonsense] without specific examples. And the last thing we need is to figure out how to make this evil monstrosity called Obamacare pervade the industry. It will only do what it was designed to do, which is destroy private health insurance and private health care. Doctors are being turned into indentured servants.

5. Exchange should use MNCM data. Now this is an all too obvious piece of self-serving [nonsense].

6. Provider data on exchange unnecessary. There is no need for the exchanges, period. How … have we managed to survive without them, survive without the government interference that has caused costs to skyrocket ever since the invention of Medicare and Medicaid?

7. Don't limit care, no matter the cost.  The cost savings promised in Obamacare can be and will be realized only because of the death panels set up to deny care to people. We are going down the same road that communists have put in place in Eastern Europe after WW2. I used to live across the street from a major hospital. No one over 55 ever came back alive, no matter why they were admitted. Huge savings on retirement and medical expenditures.

Vici Oshiro  (10)  (10)  (10)  (10)  (10)  (0)  (0)

5. Exchange should use MNCM data. And lots of data from the group at Dartmouth based on Medicare data.

7. Don't limit care, no matter the cost.  We spend too much on old folks like me.  Need to give higher priority to the young.

Scott Halstead  (10)  (10)  (10)  (5)  (10)  (0)  (0)

4. Exchange should include provider data. This is not possible for many people.  We usually don't know in advance what medical services [will] be needed when we are selecting health insurance.

6. Provider data on exchange unnecessary. We utilize Consumer Reports, Angie's List and other resources to obtain information on the quality of goods and services.  The same information should be available before selecting medical care sources.  That will drive providers to improve their quality and outcomes.

7. Don't limit care, no matter the cost.  We should be utilizing similar plans to implement the quality of the Minnesota legislature and Governor.  We need to get the quality and quantity of legislation measured and reported to the general public reported so they can rely on accurate information when voting instead of wasteful advertising and campaigning.

Roger A. Wacek  (0)  (5)  (5)  (0)  (5)  (5)  (0)

This activity is like shuffling the deck chairs on the Titanic with the total take-over of the sickness care system that we call health care.

Mina Harrigan  (10)  (10)  (10)  (10)  (10)  (0)  (0)

Tom Spitznagle  (10)  (8)  (8)  (9)  (8)  (2)  (1)

Jim is a good head based on my recall of his work during our mutual employment at Health Risk Management in the 90’s.

Wayne Jennings  (10)  (10)  (10)  (5)  (5)  (1)  (1)

There is urgency about quality and cost of medical care. I appreciate the Caucus working on this issue. Walt McClure provides excellent commentary because of his experience and long-standing interest.
 
Is there a way for us citizens to exercise pressure at the right time and in the right way? I once heard a Legislator comment on a "groundswell" of public opinion about a bill. He later admitted that the groundswell was 4 phone calls. 

Paul and Ruth Hauge  (8)  (7)  (7)  (8)  (5)  (4)  (3)

Bright Dornblaser  (10)  (10)  (10)  (10)  (10)  (1)  (1)

Carolyn Ring  (8)  (8)  (7)  (5)  (7)  (5)  (2)

ReNae Bowman  (10)  (0)  (3)  (10)  (10)  (2)  (5)

Jerry Fruin  (8)  (8)  (9)  (8)  (7)  (3)  (1)

Lyall Schwarzkopf  (9)  (9)  (7)  (8)  (6)  (4)  (3)

Al Quie  (10)  (10)  (10)  (5)  (10)  (0)  (0)

Pam Ellison  (8)  (3)  (10)  (5)  (10)  (0)  (5)

2. Wrong incentives now in force. Unfortunately, perverse incentives are in force today that reward more spending on health care, irrespective of need or results. I actually believe that there is rationing of care and that claims are routinely denied and not paid due to insurance companies knowing that about 60% and more of patients will acquiesce and pay the bill, even if it is clear their health plan should be paying the bill.  Doctors are more often than not pressured to not treat their patients if it may involve surgeries, even though the patient may have complied with all of the requirements of their benefit plan and are in fact entitled to the benefit.  I think there is also widespread under-utilization of health plans by healthy patients and therefore there should be a certain leveling factor financially that corrects those few patients that overuse the system.  I also believe there is pressure to have every clinic to have the latest and greatest medical diagnostic equipment such as MRI machines and mammography machines.  A good example is that maybe 10 years ago or more, my clinic did not have their own mammography machine and we were required to go across town for a mammogram.  You know, I didn’t mind going further away, particularly if it saved the health plan some costs and kept my health care costs as a patient from rising in the form of premiums.  I don’t think that every clinic needs to have all of the high tech equipment in their arsenal, if there are other locations nearby that can be utilized, especially in large metropolitan areas.

First of all the problem is more complicated than just considering this one aspect of health care costs.  I gave the example of the overspending of every clinic and hospital in an effort to attract more patients to their facility; the competition and waste is horrendous with regards to high tech machines needing to be in every clinical facility.  I just don’t agree.
 
The largest concern I have has to do with the rationing of care.  Patients in good faith generally, I believe should be afforded all of their benefits they are paying for that are outlined in their Schedule of Benefits.  Particularly when it comes to elective, but necessary surgeries or procedures.  When an accountant can tell a doctor and dictates to a doctor how he/she will treat the patient, that is going too far.  I have experienced this situation firsthand, and realized after I did more research, that this is the way in which the culture of insurance works, as I mentioned above.  Patients cannot just rest in confidence that they actually have the benefits that are in their Schedule of Benefits.  The insurance companies have gotten away with these underhanded tactics for years and will continue to do so, as long as they are making money or keeping money from being paid out for individual benefits. They know what he risks are and they have all of this gerrymandering down to a science.  ( I reference the documentary “Sicko” by Michael Moore, where it is brought out that several people in the healthcare industry know and are actually trained to deny claims, knowing there are a certain number of folks will pay themselves even after the first denial, because they do not have the time nor tenacity to fight against a large insurance company and jump through additional hoops, even though they know they should be covered based on their benefits package.  Mainly the highest cost of healthcare is the administrative paperwork and that the insurance and health care industry has failed to streamline the billing process by so much as insisting that there be one universal claim form for all insurance plans.  This would greatly reduce the staff required to process multiple claims to multiple providers.  In addition, they pay to market their plan and to lobby at the state and federal level, which is costly, when you think of how many legislators and members there are to influence.
 
The bottom line is profit and greed to the large insurance companies, pharmaceutical companies, and other companies that develop treatments, equipment and durable medical equipment. We have reached a tipping point in the country where there are more and more and more uninsured and underinsured, and the middle class taxpayer pays the high costs of care for this segment of the population [that] cannot afford their care.
 
We as a nation continue to thumb [our] noses at the more thoughtful way in which the rest of the industrialized world covers the healthcare of their citizens for less per capita, and still provides the services needed.  The USA pays almost triple per capita and does not cover all of their citizens.  It seems to me there is a lot more going on in the rising health care costs we are experiencing in our country.
 
Throw in the fact that we have many physicians vested in the pharmaceutical industry (which should be a conflict of interest), and we continue to allow the pharmaceutical industry to “peddle their pills” in the media, encouraging the general public to ask their physician to prescribe their pill solution.  In my opinion, we over prescribe, and under treat the real problem.  We cannot be [a] nation that just treats the symptoms and never solves the underlying problems.  The healthcare system in my opinion is just as corrupt and broken as the banking industry is, and there is little done to oversee some of these issues.
 
In addition to over-prescribing, the American household is overcharged for prescriptions in our own country because most other nations have comprehensive healthcare that caps the prices they will pay for formulary items.  But Big Pharma has no worries, they just pass on the profit gap on to Americans, because they cannot make large profits internationally, they pass those bills on to us.
 
I have lived in a country with single payer health care style of health care and appreciated the care, treatment and fact that the system has a built-in way to keep costs in line without taking away patient benefits.   I agree that the patient needs better information to make better-informed choices about physicians and clinics and care delivery based on excellence of treatment, access as well as affordability.  However the health care mess is far more complicated than dealing with this one aspect.  I do not believe all that is espoused by this speaker, though relevant to the public making well-informed decisions, would solve all that is broken in the current system.
 
We cannot continue to ignore the insatiable greed in the health insurance industry any longer.  There may need to be added regulations that come into play with regards to what is a reasonable charge for all services and these services need to be monitored and capped so we can continue to deliver healthcare to the average American.

Chuck Lutz  (9)  (10)  (8)  (10)  (9)  (1)  (1)

Robert J. Brown  (10)  (10)  (8)  (10)  (6)  (5)  (0)

    

The Civic Caucus   is a non-partisan, tax-exempt educational organization.   The Core participants include persons of varying political persuasions, reflecting years of leadership in politics and business. Click here  to see a short personal background of each.

   Verne C. Johnson, chair;  David Broden, Charles Clay,  Bill Frenzel, Paul Gilje,  Jim Hetland,  Marina Lyon,
Joe Mansky,  John Mooty,  Jim Olson,  and  Wayne Popham 


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The Civic Caucus, 01-01-2008
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Verne C. Johnson, chair, 952-835-4549,       Paul A. Gilje, coordinator, 952-890-5220.

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