Middle-School’s Back in Session — and, So is Congress: More Health Care Reform Hearings!

That light — in the distance — is most-definitely not the end of the tunnel — it is the oncoming train’s headlights. Confidential Note to Big Pharma: It is time. to. get. off. the. tracks.

This is the first of three hearings, due to be held in quick succession, before the November elections. . . . Expect much to be made of “profiteering” by pharma — as well as much rhetoric on “commerce coming before science” — again, in pharma. Here’s the run-down on the three scheduled hearings:

September 9 -– Improving health care quality –- examining the importance of measuring and improving the quality of care provided to patients in all settings and learning more about quality improvement initiatives in the private sector.

September 16 –- Delivery system reform –- creating a patient-centered model of care, understanding the importance of primary care and developing new approaches to shore up its role in the health system. [Potentially the most damaging — to Big Pharma’s “business as usual” models.]

September 23 –- Insurance market reform -– exploring ways to improve access to coverage through pooling arrangements, or through the creation of a health insurance exchange or “connector” -– connecting individuals, small businesses and those eligible for premium subsidies to available health insurance plans.

The Full Witness Line-up — for the first Senate hearing:



“Improving Health Care Quality:
An Integral Step Toward Health Reform

September 9, 2008, at 10:00 a.m.,
in 215 Dirksen Senate Office Building

Member Statements:

Senator Max Baucus, MT

Senator Charles Grassley, IA
[Click on each name, above, and below,for full-text, easy-view versions of the statements.]

Witness Statements:

Peter V. Lee, J.D., Executive Director, National Health Policy, Pacific Business Group on Health, San Francisco, CA

Samuel Nussbaum, M.D., Executive Vice President for Clinical Health Policy and Chief Medical Officer, WellPoint, Inc., Indianapolis, IN

Gregory Schoen, M.D., Regional Medical Director, Fairview Northland Health Services, Princeton, MN

Kevin B. Weiss, M.D., President and CEO, American Board of Medical Specialties, Evanston, IL

William L. Roper, M.D., M.P.H., Dean, School of Medicine, University of North Carolina and Vice Chancellor for Medical Affairs and CEO, UNC Health Care System, Chapel Hill, NC

By Order of the Chairman:

Max Baucus (D, MT),
United States Senator,
and Chairman, Senate
Committee on Finance

And By:

Charles S. Grassley (R, IA)
United States Senator
and Ranking Member,
Committee on Finance

We’ll have LIVE video, and when the below-light is “ON” — Live-Blogging NOW underway — so do join us!

We’re underway — the WellPoint MD is doing a nice job of laying out the case for preventing health issues — highlighting how much worse — the cancer treatment options are for African-American women, in particular — given how much more often they are, as a group, to remain undiagnosed for breast cancer, until much later in the malignancy phase.

These sorts of outcomes do not comport with a truly-civilized society, he here argues — and I agree.

Breaking away — to put up a new Vertex story, above. . . . back shortly.

Dr. Roper now addressing discretionary surgeries — and the drain that represents on an already-overburdened delivery system, by shifting resources away from primary care. That is certainly a fact.

Earlier, Dr. Roper said that “achieving quality isn’t simple. But it is more critical than ever. We have reached a vital tipping point -– a realization that incremental reforms and continued neglect of our most pressing challenges must end. There is a social and economic imperative to comprehensively rethink and reform America’s health care system. . . .”

Dr. Nussbaum suggested, on behalf of WellPoint, that the Senate Finance Committee, might, “as our healthcare system continues to evolve. . . . remain committed to driving quality outcomes, safety, and affordability, as an individual health care stakeholder and together as part of the health care system.” To do so, he requested that “. . .the Committee embrace the following strategies:

• Support the Institute of Medicine recommendations for the establishment of a national clinical effectiveness assessment program;

• Continue to create incentives for the adoption of e-prescribing and health information technology;

• Adopt and support innovative payment methodologies that reward quality and superior
clinical outcomes;

• Partner with WellPoint on national drug, vaccine, and health care safety initiatives. . . .”

Dr. Nussbaum (for WellPoint) also advocates e-prescriptions: “. . . .e-prescribing provides measurable benefits in drug quality, safety, and cost savings, it is most beneficial as a gateway to more widespread adoption of health information technology and deployment of integrated health records. Patients see multiple physicians who prescribe multiple prescription medications that patients fill at multiple pharmacies. Laboratory and diagnostic testing are often performed by different institutions, with results often sent only to the ordering physician. With this disconnect among health care providers, the risk of unnecessary, duplicative, or harmful care is great. By combining physician, hospital, ER, laboratory, imaging, and pharmacy data into a single integrated health record and connecting physicians, patients, and clinical data, a consistently informed virtual care team is created. This enabling of shared, informed decision making at the point‐of‐care provides the single most promising health information technology innovation to advance healthcare quality. . . .”

Peter Lee, for the largest purchasers of health care, offered the following: “. . . .As a nation we spend far more on health care per capita than any other country in the world — $6,697 for every man, woman, and child in 2005. Yet, the United States ranks only 37th out of 191 countries in providing quality care, and we have the highest proportion of the population without health care coverage of all industrialized nations. For employers and for consumers – who have faced premium increases of over 125% in the last eight years alone – these costs have stark implications. For many small employers, they are being priced out of the market entirely. And, for large businesses, these costs put American businesses at a disadvantage compared to their foreign competition and add impetus to the last export we want to foster – American jobs.

Americans believe in value – most shop to get the best quality possible for their money. Yet, no one is getting good value for their health care dollar. Our health care system is broken:

• Quality of care varies dramatically between doctors and hospitals, but those differences are invisible to patients.

• Payments reward quantity over quality and fixing problems over prevention.

• Lack of standardized performance measures makes it impossible to know which providers are doing a good job, and those who are not.

• Consumers lack information to make the choices that are right for them.

The good news is that across the political spectrum and the range of interest groups there is agreement that reform must look at coverage and financing, and also at improving the quality and cost-effectiveness of care. The good news is that there are solutions that we can work with. Our challenge, however, is to go beyond the aspirational goals of promoting prevention, better care for those with chronic illness, enhanced competition and improved technologies to concrete and actionable proposals that will improve quality and control costs. . . .”

I think I’ll set Mr. Lee’s points as a new post, above. Look for it.

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