I had the profound honor of representing The Alliance in testimony to the Senate Finance Committee this week. It was both a humbling and motivating experience.
This was the first hearing in an effort to forge bipartisan policies to mitigate the tremendous impact of chronic disease on patients, caregivers and our nation as a whole.
The testimonies of the patient and caregiver were poignant and compelling. The patient, Stephanie Dempsey, suffers from multiple chronic conditions, most notably a hereditary cardiac condition which has already claimed the lives of her sister and grandmother. The caregiver, Mary Margaret Lehmann, is managing the health and life of her husband of 50 years who has Alzheimer’s disease.
While their stories were different, a common denominator was the lack of coordination in the health care system, and the detrimental impact this has on what is already a tragic and difficult circumstance. The stories of medication errors, poor communication between physicians and no guidance about where to go and what to do next compounded the health and financial challenges for these families.
The provider who testified, Dr. William A. Bornstein of Emory Healthcare in Georgia, explained part of the problem – fee for service payment systems. He explained that Emory Healthcare is hiring and training nurse coordinators to embed into primary care practices. These nurse coordinators will identify high-risk patients and work proactively to ensure they get the care they need in a patient-centered and coordinated manner.
The business model problem for Emory Healthcare and other provider systems is that the cost of nurse coordinators is typically not covered. In addition, if the nurse coordinators are effective in helping patients manage their conditions, the health system generates less revenue due to fewer emergency room visits, tests and procedures.
The stories I heard this week illustrate the important role of payment redesign to accelerate improvement in health care delivery and to control costs. The Alliance has been actively working toward this goal for over a decade through the contracts we hold with providers in our network and through policy advocacy at the state and national level.
And it’s not enough. That’s why The Alliance Board approved a new strategic initiative as part of our FY15 business plan to explore more fundamental changes to how we buy health care. We don’t yet know what this might look like, but we are committed to finding ways to use our role as purchasers of health care to create much needed, faster progress.