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The future of health care.

Going to the doctor will become a different kind of experience in the future, if Indiana fills a prescription for health-care reform recently submitted by a state panel.

The Indiana Commission on State Health Policy in November unveiled a hefty plan called "HoosierHealth Reform." The 17-member commission spent three years researching the root problems within the health-care system, considering various solutions and developing recommendations. The group was chaired by CEO L. Ben Lytle of The Associated Group and included legislators, doctors, hospital administrators, leaders from the business and labor sectors, and consumer representatives.

"Quality of care, or the lack of it, is the root problem in the health-care system," the commission maintains. "Rising health-care costs are driven by a lack of quality health care." But the United States is supposed to have the highest-quality health care in the world, isn't it? Perhaps by some definitions, but not by the commission's.

"Quality is defined as a health-care intervention that improves the patient's condition in the most effective way at the most appropriate place," the report states. The current system offers care that can improve a patient's condition, but not always in the most effective way or at the most appropriate time or place. That's a major problem the commission tried to address. "Evidence indicates that 20-25 percent of all health care is unnecessary and that a large percentage of that unnecessary care is harmful."

The commission decided that change would have to be comprehensive if it's made at all. "Every major aspect of the health-care system must be addressed if reform is to be meaningful and have a predictable and positive outcome," the report states. "Any solution which is not comprehensive will address only a segment of the system and may cause unexpected, undesirable effects or even create additional problems."

With that in mind, the report calls for basic changes in the way all care is delivered. A key component is the creation of teams of providers. Under the concept, a primary-care physician--such as a family or general practitioner, pediatrician or obstetrician--coordinates a patient's care. The primary-care team arranges all services that the patient needs, to be performed either by team members or through referrals to other doctors or teams.

How will this achieve the aim of delivering the highest quality of care at the lowest possible cost? Commission members believe quality will increase because one entity is responsible for all the care a patient needs. "An unnecessary procedure, an inaccurate diagnosis that causes ineffective treatment, or a refusal to refer a patient when needed will become apparent overtime. Enrollees can vote with their feet and choose another team if they suspect this kind of treatment, and the market will eventually select the most efficient, high-quality teams."

Patients whose needs are more severe than can be handled by a primary-care team move into the jurisdiction of critical-care or acute-care systems. The critical-care system would cover patients with the most severe conditions, while the acute-care system would be for patients whose needs are less serious than those served by the critical-care system, but more serious than those handled by primary-care teams. A key component of the reform would be getting these providers to accept payment in some form other than the standard "fee-for-service" arrangement, which critics say encourages unnecessary tests and treatments. One proposed alternative would be to pay a fee based on the diagnosis, a fee that would be the same whatever tests or treatments are ordered.

Further improvements in the system can be made by reducing the risks doctors face if they choose a proper treatment but the outcome is negative, as well as increasing the risks for those who render inappropriate care. This means the state would need to set up guidelines proclaiming exactly what is considered appropriate treatment.

HoosierHealth Reform would bring uninsured people into the picture through Medicaid for the long-term uninsured and through a voluntary low-cost insurance program for the short-term uninsured, such as those switching jobs. Ultimately, under the commission recommendations, "health insurance as we know it is eliminated by the year 2000 and replaced with coordinated-care plans," health plans designed to steer patients to the appropriate type of provider.
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Author:Kaelble, Steve
Publication:Indiana Business Magazine
Article Type:Industry Overview
Date:Jan 1, 1993
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