Question: How should healthcare be overhauled?
Nicholas LaRusso: Our new president [Barack Obama] has identified as one of his three major areas of attention, health care which by the way I personally applaud and Mayo has worked through its health policy institute to articulate the four pillars that are necessary for transforming healthcare. Those 4 pillars then provide the environment with which the Center for Innovation, and innovation across the country in health care delivery can evolve.
Those pillars are pretty simple. Conceptually, they include creating value, coordinating care, restructuring the payment system, and providing universal access. Those are the four pillars.
For the innovations that we envision helping to catalyze through our Center activities, to be maximally effective, there needs to be policy changes that address those four areas. Care coordination, value, payment reform and universal access.
Topic: An example of healthcare reform.
Nicholas LaRusso: If you’re in charge of a delivery system, and you’re being reimbursed because of the quality or value of the care that you provide, and because of the coordination that you provide, rather than on the number of tests that are done, then that provides a whole different set of incentives for you to reorganize the way you deliver health care.
This gets back to one of the four pillars of our policy initiative, and that is payment reform. Right now the payment system results in just what you expected it to do. That is, if people get paid because they do a lot of stuff, they’re going to keep doing more and more stuff to get more and more pay. But if you pay people for the quality of what they deliver, and you define quality or value, and you have metrics for value, and you make those metrics publicly available so the consumer knows where to go to get the highest value care, and you coordinate things.
Recorded on: June 24, 2009.
Discuss
Infinity on July 2, 2009, 1:32 PM
I searched around the internet for something that Dr. LaRusso was talking about in this bigthink interview, and I found an article that refers to what LaRusso calls the “four pillars” ……
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Over the last two years, Mayo Clinic Health Policy Center has gathered hundreds of national thought leaders for a series of events to help develop new, consensus-driven principles to guide the reform process.
Participants recommended four areas of focus: insurance for all, coordinated care, value and payment reform. Using these cornerstones as a baseline, participants at the Virginia symposium developed a handful of action steps for the private sector and the next president/Congress to address. Recommended actions include:
Private sector action steps:
* Payment Reform
Make the case for payment reform with properly aligned incentives (outcomes, prevention, wellness, “virtual” appointments, etc.).
* Universal Clinical IT
Establish universal use of interoperable electronic clinical information technology systems (systems that can share information).
* High-Cost Service Program
Develop care programs for high-impact/high-cost services (end-of-life care, chronic diseases, etc).
* Coordinating Care Team
Incent delivery model which provides a defined care coordinator for chronic and acute conditions (i.e. medical home).
Government sector action steps:
* Insurance for All
Ensure/mandate insurance coverage for all.
* Interoperable EMR
Require all providers to have interoperable electronic medical records within a certain time (4-5 years) with patient accessibility.
* Pay for Value
Direct Medicare to pay for value/outcomes/prevention using innovative payment models.
* Federal Health Reserve
Implement an independent “Federal Health Reserve Board” to set rules/standards to promote value in health care.
* Care Coordination
Reward care coordination (whether provided by primary care provider, specialist or other caregiver).
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I copy-and-pasted the above extract from a March 2008 article athttp://www.mayoclinic.org/news2008-rst/4705.html
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