Category Archives: Health Reform

Improving Mental and Behavioral Health in Our State

UNC Health Care is committed to caring for all patients, including those with mental and behavioral health issues. As our population grows, the demand for beds and dedicated inpatient psychiatric care continues to rise.

In Wake County, more than 65,000 people suffer from a serious mental illness. Yet, from 2012 to 2015, we were one of just three states to decrease behavioral health spending each year. More than half of our counties are without a psychiatrist, and only 35 percent of our hospitals have a psychiatric unit.

Regular hospitals and health facilities often don’t have the time or resources necessary to help treat and provide services for those with mental health, behavioral and substance abuse problems.

At UNC Health Care, we are taking steps to address this growing need. At UNC REX, we have worked to improve our triage process in the emergency department to ensure that mental health patients get the care they need as quickly as possible. We also recently expanded UNC WakeBrook, a facility in Raleigh designed to care for those with mental health, behavioral and substance abuse problems.

At the federal level, we are pleased to see policymakers making mental and behavioral health a priority as well. Late last year, the 21st Century Cures Act was signed into law.

Among many other things, the Act strengthens laws mandating coverage parity for mental health care and provides funding to help increase the numbers of psychologists and psychiatrists.

The expansion of WakeBrook and the 21st Century Cures Act are steps in the right direction, but there are always opportunities to do more. We will continue working closely with public health officials and legislators to provide better care and better access to our state’s mental and behavioral health patients.

 

The State Of Things: My View on Health Care in America

I recently was interviewed by Frank Stasio on WUNC’s “The State of Things.” We discussed the health care challenges our country faces, including gaps in mental health and preventive care, among others. I also discussed some of the myths about health care in our country and explained how UNC Health Care is working with others to provide high-quality affordable care and to train the next generation of physicians.

Listen to the full interview here.

What will health care look like in 2020?

The delivery and coordination of care in our country and across the world continues to change. On Feb. 26-27 in Raleigh, leaders in health care will gather to discuss the future of health care at CED’s Life Science conference. As a conference co-chair, I hope you will join me to explore how the convergence of medicine, technology and regulation will impact health care moving forward. To learn more about the conference and why you should attend, please view the video below.

 

Today’s Supreme Court action

One critical tenet of UNC Health Care’s mission is ensuring that patients have access to excellent and affordable care. The Supreme Court’s action today will continue to help make that possible, as the almost one in five North Carolinians who do not have health care insurance will now have coverage. Evidence clearly shows that those who do not have insurance are less healthy than those who do. I am hopeful this decision will lead to a healthier and more productive North Carolina.

Health care providers across the nation, including UNC Health Care, have been reacting to the realities in health care through industry consolidation, partnerships among hospitals, physicians and other health professionals and an increased emphasis on shared responsibility for improving health outcomes and reducing costs.

Annual North Carolina Leadership Dinner

Raleigh, NC

Yesterday evening, I spoke at the North Carolina Leadership Dinner as part of the 2011 Emerging Issues Forum, presented by the Institute for Emerging Issues at North Carolina State University. Each year, the Forum brings together leading thinkers and decision makers to foster bigger and better ideas for innovation and improvement of our state and nation. I have included my remarks below.

I have been working on improving the public’s health for almost 35 years. And as I look out in the audience, I know that many of you have been in the trenches for as long, or longer than I have.

We are fortunate in this state – and especially fortunate in this region – to have access to some of the best medical care this country has to offer. I arrived in this state a little over a decade ago. The decisions that our state’s leaders made long before I arrived, and the teamwork with which they approached the challenge of building modern health care in North Carolina paved the way for all that we enjoy today.

But through the years, there have been several activities that I am especially proud of:

From fluoridating the public water supply in my home town, Birmingham, Alabama, to starting Medicare’s efforts to publish information allowing quality comparisons across the Nation’s hospitals.

From adding “Prevention” to the name of the CDC, and making prevention a practical reality in the Nation’s health system, to creating the NC Institute for Public Health, the outreach and service arm of UNC’s school of public health.

And from building the NC Cancer Hospital to implementing the new University Cancer Research Fund, I am deeply proud to have been involved in each of these efforts – but I am by no means claiming exclusive credit for any of them – they were very much team efforts. These achievements required lots of people, many organizations and institutions, working together to do challenging and important things to improve the public’s health.

For most of these years, I also have been working on reforming the American health care financing and delivery system – beginning with my work as a lower-level White House staffer for President Reagan.

I did the staff work for his health reform package from his State of the Union speech 28 years ago. I am sure you all remember it, right?

No, you don’t, because it did not get enacted.

Many health reform efforts – by many administrations – over many decades – went nowhere.

Of course, last year President Obama and the Democrats in Congress passed the Accountable Care Act. And promptly, the Republicans began the repeal effort.

It is too early to say how all this will turn out – and it is not my purpose this evening to speak in favor of or against the ACA.

Many of you know this, but let me be plainspoken. I have been appointed to political positions by three Republican presidents – Reagan, Bush 41 and Bush 43. At the same time, Nancy-Ann Deparle and Don Berwick – the key people on health reform for President Obama – are close friends of mine.

So I believe I have a reasonably balanced perspective on health reform.

You do not need me to handicap what’s going on in Washington – there are plenty of others who are doing that – take your pick.

But I will make one point – the various activities I mentioned at the beginning of my talk this evening – things I’m proud of being a part of over the years – they were team efforts – made possible by broad-based, bipartisan collaborative work.

We very much need a team effort to fix health care in America – and here in North Carolina.

Of course, there are limitations to what a single state can do, acting alone. But that should not be an excuse for total inaction.

That’s my message this evening – to all of us here convened by Governor Hunt and the Emerging Issues Forum – all of us, consumers and providers, business leaders and elected officials, rural and urban, Republicans and Democrats.

I believe the single biggest thing holding us back from thoroughgoing reform of our health care system is that we each believe that somebody else needs to change, needs to reform. If only they would do it, then all would be well.

I think we are the collective victims of our concerted efforts to blame someone else. Or to believe some things that just aren’t true.

What I am going to do with the remainder of my time this evening is empower us to rethink our long-held assumptions, and to move us from our comfortable, but mistaken, positions. This will guide us toward a team effort to build a much better American health care system, starting here in North Carolina.

So, here is my list of the top things we know for sure about health care – things that are not true.

1. The American health care system is the best in the world.

For all the good it does, it really needs a major overhaul. I believe the oft-reiterated slogan that our country’s system is the “best in the world” is evidence of a desire to keep everything as is. I am an “American exceptionalist” too, and I know that some of you hate international comparisons – but it is simply undeniable that on average, outcomes of care in the US are not as good as average outcomes in many other industrialized countries. This is mostly because of our inability to close the disparity in the health outcomes for certain ethnic or racial minorities.

The international comparisons are not looking at the best each country has. They are comparisons of where things are on average – from top to bottom. And our bottom is what pulls us down. These people spend large parts of their lives outside the health care system. They haven’t seen the inside of a doctor’s office for years. They know only the ER at a hospital as their usual source of care. When it comes to a national average, they get equal billing with those who take advantage of the best we can offer.

2. Everybody eventually gets the care they need.

Repeated studies have shown conclusively that there is a huge cost to American society of “uninsurance” – people seek care later, have worse illnesses and worse outcomes. And we have the crazy quilt of cross subsidies – paying customers pay much more to cover the cost of uncompensated care – for UNC Health Care, which includes Rex Healthcare here in Wake County, that’s $300 million this year.

3. Almost always, the quality of care people get is very good.

Many researchers, especially Dr. Beth McGlynn at RAND, have shown that far too commonly, people do not get the care they need – and others like the Institute of Medicine have shown the harm done in the processes of care because of the lack of attention to patient safety. I chair the board of the National Quality Forum, and we are working with all parties at interest to measure and report results and then to drive vast improvements in care quality.

4. The cost of care in America is not really a problem. It is a clean, non-polluting industry that employs millions of people. And at a time when the economic problem is “jobs, jobs, jobs,” health care is one sector where employment continues to grow.

Health care now represents 17 percent of our economy, which is far more than any other country. At a time when we are worried about our competitive position in the world economy, this has to be a concern. And the Medicare actuary has just said that health reform is going to add to aggregate health spending.

Let me be even more emphatic – proposals for health care reform that do not take cost control seriously should not themselves be taken seriously. Indeed, that is a major shortcoming in last year’s legislation.

5. If you like your care, nothing about it will change

This is a line often used by President Obama. Unfortunately it is one of the most hurtful of these mistaken ideas. Because almost everything about American health care must change if we are to be successful in overhauling it as I am suggesting.

We need to redesign care in fundamental ways, to create coordinated care across primary and specialty doctors and others, so that each of us has a “patient-centered medical home.” As I hope you have heard, that is what we are doing in a very innovative pilot medical office with Blue Cross Blue Shield of North Carolina.

This initiative, if successful, could help avoid putting consumers in the middle of health insurance conflicts.

Let me say a bit more about health reform. The news media focuses on conflict in the health care debate. That focus keeps attention from an emerging Washington consensus on health care. In watching the back and forth between Republicans and Democrats, we pay no attention to what they agree on.

They agree that on the fact that future government will take less of the financial risk attributed to growing health care costs. Yes, they disagree about who should bear the risk instead, and how that risk should be borne. Democrats in Washington prefer solutions that put more risk in the hands of health care providers, and Republicans want individuals to deal with more of the risk themselves. But we should not let this back and forth cloud the reality that both parties are telling us that the government will take less of the risk. Both parties are saying that some parts of the health care system will have to change in the future.

Let me say again – we very much need a team effort to fix health care in America – and we need to do that right here in North Carolina.

I have tried to tell you the truth, about a series of long-held and unfortunately mistaken ideas about health care. You might be sitting there frustrated, and even disappointed with what I have told you.

I am hoping that as I went through some of the myths about our health care system, many of you thought, “Well, Bill, you’re right.”

The problem is that the myths don’t go away. Ours is a free country, and everyone is entitled to believe what he wants. And unfortunately, I think the average North Carolinian is not yet on board to face the challenges ahead.

There is a vast gap between the experts and the public on health care. For example, there is a consensus among those who do research on our health care system that much care that is delivered is unnecessary. But that is not the view of the average American. When surveyed, 67 percent said they do not get the tests and treatment they need. Only 16 percent said they received care that was unnecessary.

This divergence of views has had a powerful impact on what happens when health care experts suggest ideas to politicians about how best to go about dealing with lowering costs. By going along with the experts’ assumption that we have unnecessary care, those politicians created an opportunity for their opponents to reach the 67 percent who think they do not get the tests and treatments they need. And that, I would suggest, is how the term “death panel” gained such potency.

The reason we continue to over-treat is three-fold:

  • Patients demand more
  • Most health care is paid for on a fee-for-service basis, so the more you do the more you make
  • Our medical liability system makes providers reluctant to say no to patients.

Those who expect individual consumers to make more cost aware choices also have reason to be disappointed. Only 22 percent of Americans say they have ever asked about cost when making health care choices.

As someone who has worked very hard to create information that would allow comparisons of health care providers, I find it disheartening to learn that 70 percent of Americans believe there are no big differences across health care providers. If you don’t believe there is a difference, you will never want to look for anything better.

In a free market, the consumer rules. At this point, the consumer is not open to much of what the experts recommend.

As we try to rally the citizens of North Carolina and the nation to take on the challenge of health care overhaul – a major problem is this disconnect between the “experts” and the “average person.” I confess to being a health policy wonk – and we “experts” have long been concerned with the issues on my list above.

But the typical hard working North Carolinian – who today may hold down two jobs and surely wants to be responsible – all too often cannot afford the co-pays and deductibles if he has a sick child, especially one with a chronic illnesses.

That is what real people are worried about. And we owe it to them to come together to work on these real issues with vigor and determination, not just hunkering down with our long-held positions and slogans.

Our state has long had a proud record of innovation and leadership in health and health care. With the ideas and energy that you and the Emerging Issues Forum speakers have brought to this conference, I am very hopeful.

Yes, I mean those words. I am hopeful, but they can surely sound like high-minded platitudes. It is not enough for us simply to say “let’s work together.” We actually have to do it.

There is an old Greek proverb: “A society grows great when old men plant trees whose shade they know they shall never sit in.”

Friends, young or old, let’s go out – together – and plant some trees. With teamwork, we can do great things for North Carolina.

Pre-State of the Union Reflections

President Obama’s upcoming State of the Union speech will be met with high expectations. Not only is this his first chance to address Congress since the November election, but it comes on the heels of eloquent remarks about the importance of civil public discourse following the Arizona shootings that drew praise from both sides of the aisle.

The President’s speech will give us some clues about how the rest of his term could go, particularly as it relates to Congressional relations. This is most important in the arena of health care reform. The House just this week passed a bill repealing the Affordable Care Act, but this measure will likely fail in the Senate. There is no doubt that the public is divided about whether the new health care reform law is the right approach for improving care, increasing coverage and reducing costs.

The next few months are expected to usher in a period of continued debate about changing federal health reform legislation. The State of the Union speech should tell us what President Obama hopes to achieve.

I hope the President will mention progress on the much-anticipated rules for accountable care organizations (ACOs) being written by the Centers for Medicare and Medicaid Services. The broad outlines for how ACOs will operate are becoming clearer, but many of the details are yet to be ironed out. ACOs could have a profound impact on how Americans access quality care in the future: This system would provide a financial incentive for reliable performance measurement and improved outcomes.

I hope the President also will recognize that profound change is sweeping through health care independent of the ongoing Washington debate: industry consolidation, greater partnerships between hospitals, physicians and other health professionals, and an increased emphasis on shared responsibility for improving health outcomes and reducing costs. I recently spoke with UNC-TV’s NC Now about these changes.

Regardless of what happens at the federal level, it seems clear that health care delivery models based on patient volume alone is not sustainable. UNC Health Care is moving swiftly to put in place new arrangements that make possible more cooperation and between primary care, in-patient care and specialty providers.

One way UNC Health Care is working to keep pace with these changes is our innovative, first-of-its-kind partnership with Blue Cross and Blue Shield of North Carolina to form a new medical practice based on the medical home approach. We also are partnering more closely with physician groups, bringing them greater IT resources for decision making and integrating their expertise into our hospital system.

The oft-stated goals of health care reform promoted by the president and the opponents of his approach to reform are similar to the mission of UNC Health Care – improving quality and efficiency so that we can ensure patients have access to excellent and affordable care. I look forward to hearing what President Obama sees as the next steps to reaching this goal.