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On the second day of LeadingAge's Public Policy Congress, participants reconvened after a morning of sharing principles in workgroups to listen to a panel discussion on private insurers, housing and healthcare.
The panel consisted of the following acclaimed speakers:
During the hour-and-fifteen-minute long session, each speaker offered what they saw as the most pressing public policy challenges they see in the field based on their work and observation, followed by potential solutions.
Ignagni began the conversation, examining the field from both a supply and demand perspective. For providers, Ignagni emphasized the value of collaboration and coordinated care, both of which are more important than ever before. "What's markedly different now is that the story now is about collaboration. No stakeholder on his or her own can hope to solve this problem," said Ignagni.
She stressed the changing payment structure of services, noting emphatically that "fee for service has got to go." In addition,what we pay for is as important as how we pay. And more and more people will be in need of home and community based services.
As for solutions, Ignagni mentioned that America's Health Insurance Plans has been working very actively with CMS to develop high-value measures that doctors and hospitals feel make sense and that can be used across the public and private sector.
Ignagni concluded by adding, "We've been talking with members of the community that represents individuals with disabilities to start discussions there, to talk about steps that are necessary to implement successful programs, to begin to share best practices, highlight what works and what doesn't work and under what circumstances, and encourage partnerships. For those of you whoa re in the aging community, as we get our feet on the ground, and as we move forward in this arena, we will continue to reach out to you. We think that we have a lot to learn form all of you."
Karnas discussed the current environment (namely sequestration/limited resources) and how the principles that have been developed by the Public Policy Congress can be applied at the local and federal levels. He identified several challenges within the current environment, including system inertia, or what he paraphrased as "I didn't sign up for this" syndrome. "Using housing as a platform to improve quality of life, HUD creates physical locations where people are, and we can use those locations to connect people to healthcare, but I heard people saying 'that's not my job,'" he recalled.
Other challenges identified by Karnas included system inflexibility, the lack of consistent metrics, and the need to adjust to the Affordable Care Act, which significantly changed the environment. Many of these challenges occur within agencies and administrations, but Karnas emphasized that "Outside of government, there are real structural problems at the provider level. I think we've got to think about how we do things more broadly. We've got to connect."
As both current CEO of Billings clinic and former MedPAC commissioner, Wolter lent a unique perspective to the conversation that Ignagni and Karnas initiated. He began by listing a number of innovative ways that his clinic has improved care, reduced readmission rates, and reduced costs. He called for the consolidation of measures to provide a more accurate measurement of progress, and highlighted the lack of communication within care providers.
As an example, Wolter shared a personal anecdote about a time when his daughter was experiencing extreme migraines. After visiting doctor after doctor, she finally was referred to Mayo clinic. She was astounded to find, after shuttling her records from place to place and doctor to doctor, that the staff at Mayo were already familiar with her history. "They actually talk to each other," she exclaimed. Wolter used this to illustrate the kind of communication and collaboration that should be the rule, not the exception in the healthcare industry.
Finally, Wolter feels strongly that we must to continue improving the fee for service model. "Replacing fee for service is not simple, and it's going to take a little time...while we are inventing new forms of payment systems, we should continue to improve the fee for service model, because even the new forms are built on fee for service."
The panel discussion ended with an open mic, at which point members of the audience had the chance to ask questions of the panelists.