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The 6th annual employer symposium focused on ways recent health care initiatives and trends could change the way employees use health services in the future.
Employer and union health benefits representatives heard presentations from industry experts and thought leaders on the pending ; the development of statewide electronic , and the way the practice of . Keynote speaker Jessie Gruman, advocated for better communication between employers and employees to promote active and informed engagement in personal health care.
Health Care as a Second Language
Jessie Gruman, Ph.D., President
Center for Advancing Health
Drawing on her work as founder and president of the independent Washington-based Center for Advancing Health, and on her experience from three cancer diagnoses, Dr. Gruman discussed the responsibilities we have as individuals to be active and knowledgeable participants in our own health and health care. Regardless of the fate of national health care reform, these responsibilities will remain because successful care outcomes depend on confident, informed and engaged patients.
The growth of new technologies and new treatments means more choices for patients who have to consider complex options and trade-offs before deciding how to proceed. The passive role of the patient is obsolete and many things we do now used to be done by clinical staff. We need to know when to seek medical care, how to learn about conditions and treatments, how to find and choose the right doctor, and how to trust and follow through on medical advice. We also need to have the confidence to be the coordinator of our own care.
Employees’ understanding of their stake in care outcomes is lagging and they have largely ignored calls to become more educated, critical and active participants. Employers see the problems of health differently and the language they use to describe key issues is unfamiliar to employees. “Provider quality” is one example of how employers and employees think differently about a term.
Dr. Gruman recommended four things employers can do to find a common language with employees and help them understand their emerging role as health consumers. Employer strategies include (1) organizing the work place and how work is conducted in a way that sets a high bar for employee health behavior and reflects concern for health; (2) testing and respecting employees’ level of trust in worksite health activities and promoting community resources which teach skills based health management; (3) addressing the gap in understanding about health care costs and teaching employees how to maximize their health benefits, and (4) helping employees weather difficult times when illness strikes.
In closing, Dr. Gruman described how her book, “After Shock: What to Do When the Doctor Gives You-Or someone You Love-a Devastating Diagnosis”, can be used as a quick decision making guide by people who have received a bad medical diagnosis.
The Changing Face of Primary Care
Jennifer Earvolino, M.D., Director of Primary Care
Rush University Medical Center
Catherine Dimou, M.D., Medical Director
Rush Health
The changing insurance landscape, more savvy consumers interested in saving money, and a bigger focus on prevention and health information technology were some of the factors Dr. Earvolino attributed to the changes in primary care practice over the past decade. She described ways Rush University Medical Center and Rush Health supports primary care physicians with tools and resources that allow the doctor to do a better job of taking care of patients, including the use of electronic health records to facilitate care coordination and improve quality, safety and efficiency.
The advantages of practicing primary care within Rush Health's integrated health care delivery system were discussed. Dr. Dimou outlined the value of using information from the actual medical records combined with lab and pharmacy data to develop profiles of clinical performance. Dr. Dimou described how the clinical performance feedback process and financial incentives for participating in the program work to help primary care physicians identify areas for improvement.
Dr. Dimou described how the medical home is a patient centered approach to primary care requiring a partnership between an individual and their physician. She highlighted some of the national projects examining the effectiveness of medical homes and discussed barriers to the model being widely adopted.
Health Information Exchange: What’s Meaningful to You?
Mary McGinnis, Strategic Sourcing Manager
Illinois Department Healthcare and Family Services
Meaningful health information exchange is a health record electronically transmitted from one provider to another. Ms. McGinnis outlined the safety and quality of care benefits from the meaningful use of electronic health information (EHI), including immediate availability of health information when patients are admitted to the emergency room; collaboration between physicians at different hospitals; care coordination between doctors, nurses, and other providers; improved population and public health due to the ability to target outreach interventions to specific populations, and reductions in disparities of care. She pointed out that although hospitals in the Illinois Medical District, including Rush, already use electronic medical records, the exchange of health information from one independent hospital to another is not happening anywhere in our State. Illinois ranks 49th in terms of health information exchange adoption.
Ms. McGinnis described a state wide funding initiative to develop collaborations between providers in 16 “medical trading areas”. Long term meaningful use of health information exchange will involve collaborations between hospitals, doctors, community health centers, mental health agencies, nursing homes and school based health clinics. She encouraged employers to participate in the initiative.
Important issues of privacy and security are being addressed to protect consumer EHI coming from disparate systems. Exchanges will first be developed within medical trading areas, then within the State, and afterwards between contiguous States, and then nationally. The A.R.R.A. stimulus bill provided funding for health information technology and significant Federal dollars are expected to come to Illinois to support connectivity between Medicare and Medicaid program providers.
America’s Affordable Health Choices: The Good, The Bad and The Ugly
Barb Molloy
Molloy Consulting
Ms. Molloy's presentation was based on the July 14th House Bill. Although details will change as the debate continues, the structure and approach will likely stay the same: it gives an indication of how health care reform will impact employers and consumers and also support the working poor. If health care is a second language, health care reform will require us to learn a third language which uses such terms as “qualified health plan”, “clinical appropriateness” and “essential benefits package”.
Ms. Molloy explained how the House Bill defines coverage guidelines for a qualified health plan and favors co-pays over co-insurance (this will become the standard plan offered by both the government and employers); how plan costs should be split (the % of actuarial value provided by the plan and by enrollees’ co-pays); minimum loss ratios; and the three different types of plans (Enhanced, Premium and Premium Plus). She noted that coverage must include well child care to age 21 (including dental and vision care) and sets no limits on certain out-of-network reimbursement.
Specific examples were presented to illustrate how the rules for Federal assistance for medical coverage will be applied and what this would mean for people at different income levels. She demonstrated how compression of age ratios for underwriting will raise the cost of premiums for younger and healthier people and how the removal of preexisting condition limits may create incentives for them to opt out of coverage until they become sick and need services. When an employee opts out they will be required to pay a penalty tax. Employers who choose not to offer a qualified plan will also pay a tax. Rules rely on a person’s income and do not take into account assets. Other problem areas Ms. Molloy noted in the Bill were a lack of any requirement for physicians to follow evidence based guidelines or patients to be active participants in their care.
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