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LEE: About the market stepping forward and some of these private entities—quality is one issue, of course, but another important factor is to be sensitive to the student debts. As a result of tuitions being over $70,000 a year in most of these private organizations, the students can emerge with huge debt and that tends to dissuade them from going to the areas that we need them the most, like primary care. So as those entities start to develop in Utah, it is important that we encourage them to reduce their costs so that those students will be meeting the needs of the state.
If you could change one thing in Utah healthcare, what would it be?
SPERRY: From a consumer perspective, from a policy perspective and ultimately from a provider’s perspective—although providers might be a little uncomfortable up front—I think transparency of information relating to costs, outcomes, potential courses of treatment is absolutely essential for good decision-making. That’s true with the policy level; that’s true as an individual consumer.
We get questions all the time, “How much is this going to cost me?” It’s not that you want to hide it from them, you just have to say, “I don’t know. It depends on how you react to something. It depends on how your physicians practice.” The kind of information that is essential for good decision-making for markets to work is not there in healthcare, and that needs to be addressed going forward.
HASBROUCK: I’m going to echo the transparency piece. One of the questions is how important is competition in the healthcare system, and we clearly don’t have competition now, because until you know what something costs and what you are buying, I don’t know how you would have a competitive market, and it’s clearly opaque right now.
I do think that the investment in health information technology and then the potential for a health information exchange starting to emerge can support both transparency as well as consumerism.
In the Beacon project that we are involved with as a community right now, some of the changes that are happening in processes, as well as information exchange with patients, are pretty amazing. For example, cell phone technology being used for chronic disease management applications. We are dealing with an application with diabetes care and it’s basically just a cell phone—it doesn’t even take a smartphone. It’s seen significant improvements in the control of diabetes. So low-cost technology systems are emerging that we need to be aware of and incorporate into our changing systems and processes.
LEE: In terms of a change to improve healthcare, fundamentally we see a total lack of alignment between how we as providers are compensated and what we actually need to do now to reform the system. That’s the biggest hurdle that we face now—when we don’t have alignment between how the physician should be behaving and taking care of the patient, between what the patients themselves should be doing to look after their own care, and then the financial consequences of that lack of alignment. That’s our biggest hurdle.
SANPEI: I remember actually sitting in this room two years ago and we were talking about healthcare and the challenges that we needed to overcome, and the single biggest thing that we talked about was incentives. We said that was the elephant in the room. It’s somewhat of a chicken and egg thing—if we don’t make the incentives right, the innovations don’t come.
Collectively in this room, the organizations we represent worked awful hard over the last few years to start moving the industry. And now we are looking at innovative changes in terms of medical homes being done different ways, primary care being more of an emphasis and a focus.
The other major thing that we didn’t have 20 years ago are the clinical decision-making models. A lot of it is IT driven. Twenty years ago, we would have individuals come into our institutions and we would make decisions over whether they needed an MRI or a CT or any other procedure based simply on diagnoses. Now we can take those same individuals and we can risk adjust, we can add demographic information.
We are much more sophisticated about our hot-spotting and our focus of looking for the places to have additional care. As we continue to evolve, we’ll have some very significant differences in how we do care moving into the future, and in many ways it’s exciting.
MCOMBER: Any number of years ago, physicians and other providers wouldn’t have had any of the data about any of the care decisions they made other than their own rate that they charge the patient. They wouldn’t know how much medications cost. They wouldn’t know how much a lab costs. They wouldn’t know any of the other cost pieces. So they would always be the ones who were, in a sense, blamed for the cost of care, saying that you are the one who ordered these tests and so you control the cost.
Now they truly can look at that cost and can make decisions that are based both on the best care and the best cost decisions, and that’s helping to lower costs, and it will help to lower costs in the future.