Lola Butcher

Everyone agrees that payment reform is needed, but the enthusiasm for simply paying primary care physicians at a higher rate does not do much for George Halvorson, chairman and chief executive officer of Kaiser Foundation Health Plan and Kaiser Foundation Hospitals. Here’s what he thinks:

To make payment reform really work, we need to focus on the end points that we want to achieve in care delivery, and not focus on pieces or individual process units. We should set goals that say we’re going to cut the number of kidney failures in half-for example - and then use payment reform to incent the care delivery infrastructure to actually achieve that goal.

But the model unfortunately that people keep using is a model that focuses on little incremental units of care, or doing things like changing the reimbursement model for primary care doctors. Frankly, the suggestion that people are making is that we increase the primary care doctor payment level by 5 percent in the hopes that somehow the primary care doctors, as a result of that, would ultimately do something positive relative to preventing kidney failure. I think that’s far too indirect. I don’t think it’s a good, crisp business model.

We will be far better off if we identify the steps needed to reduce kidney failure, and then pay primary care doctors and specialists more for doing those particular steps. Instead of doing an indirect model that doesn’t really focus the energy and the creativity, we need a model that very specifically identifies targets, and then reforms payment relative to those targets.

I interviewed George C. Halvorson, chairman and CEO of Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, last week. Kaiser Permanente is the nation’s largest integrated health plan, serving more than 8.4 million members in nine states and the District of Columbia, so I am interested in what he considers the perfect health care system.

Are you ready?

“A perfect system basically says that we should have all of the information about all of the patients, all of the time, and that information should be available in real time. It should be available to the caregivers and to the patients; and the information should include information about each patient and about their conditions, and about optimal treatments for the conditions. And all of that connectivity is possible. It’s all doable. Pieces exist, but we have chosen not to put those pieces in place in a way that we should put them in place.

What I’m going to be arguing and suggesting is that we need to e-connectivity, e-visits, e-scheduling, e-linkages, that the patient should be able to get e-consults, and that the computer and connectivity should become possibly the single most important tool available to healthcare. That the computer should go from being something that just stores data and is rarely used to improve care, to being maybe the single most important tool in care–a  little bit like Bones in Star Trek, when he pulled out that little device and scanned the patient, and quickly get a sense of all of the information about the patient, and all of the information about the disease. I think that’s actually a model for where healthcare ought to go, is they ought to be creating that kind of functionality. Probably not hand-held at this point, but actually, hand-held not that far down the road.

We need computer models of the human body, we need computer models of the patient, but we also need information about each patient, and that information needs to be real time, and it needs to be focused on best care. So, I’m (advocating) about the need to move this country and our healthcare infrastructure toward the perfect system and the perfect set of connectivity, and basically say that doing anything less than that would be a huge mistake, and almost criminal relative to our patient care.”