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Remembering Mike

December 21, 1954-
August 9, 2012


New Blog Post

Four Themes to Successfully Navigating the Supreme Court Decision

The decision by the U.S. Supreme Court to uphold the controversial Patient Protection and Affordable Care Act confirms the direction of healthcare reform that had already begun a few years ago.  Many payers and providers, responding to the slowly emerging regulatory architecture of the law, have embarked on large scale transformational initiatives which will fundamentally change their business models forever.

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New Article

Payers and Providers: The Pressure On Payers Is Relentless

No matter the outcome of the Affordable Care Act, the long-term picture for payers remains uncertain. Even if all the ACA provisions are enforced by the Supreme Court, there are still many issues to sort out. If some of the provisions are struck down, then other issues will be encountered. In an unpredictable business environment, Blue Cross Blue Shield Montana decided to give itself a physical and make process improvements to control what we could control.

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Ron Wince on Healthcare Reform

Source: – July 14, 2009
By: OurBlook

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From your point of view working across the country with health care organizations to reduce costs and improve quality, is there really such a big problem or number of big problems with health care in America that a revolutionary overhaul is needed? If so, what are these problems that you see first-hand?

RW: There are several problems that are systemic in nature and drive much of the issues with our health care in the U.S.

First, there is a lack of alignment for the major participants as the current health care system is structured. Providers, payers, employers, pharma, legislation, regulation and patients lack a singular goal or focus which leads to dysfunctional behaviors from the various players. In most industries, there is a clear focus on serving the needs of the ultimate consumer. This is not the case in health care. Each player is more closely aligned and focused on optimizing their own interests than on delivering systemic outcomes that serve the needs of all.

Increasing volumes from a failed focus on health vs. health care, an aging boomer population and lack of financial resources are putting strains on the care delivery systems. Serving more patients with declining resources is becoming more critical.

There still exists a tremendous amount of waste. From simply supply chain issues to wasted tests and diagnostics to reimbursement systems managed by centers for Medicare and Medicaid which contribute to the rework and excessive costs associated with managing care ... waste is pervasive throughout the health care system.

Tell us about the Center for Health Transformation  ... who’s in it, what it does. Has it taken a stand on any health care reform legislation or announced provisions it deems essential?

RW: The Center for Health Transformation is a collaboration of private and public sector leaders committed to creating a 21st century Intelligent Health System that saves lives and saves money for all Americans. The center is based on the premise that small changes or reactionary fixes to separate pieces of the current system have not worked and will not work and that we need a system-wide transformation. CHT unites stakeholders across the spectrum including providers, employers, vendors, trade associations, disease groups, think tanks and government leaders at both state and federal level to drive transformation according to a shared vision and key principles.

The major players so far in the health care reform debate represent powerful interests such as drug companies, doctors and those who wish a big expansion of federal power, but small business plays a vital economic role in any discussion of costs to employers. What role do you see small business owners playing in the debate?

RW: At the current time, I believe that employers in general have been left out of the debate with the exception of when it serves the purpose of the powerful interests you mention. The current debate is like watching a pinball game without any regard to what the system will look like in actual execution. The major interests throw about assumptions about taxes and their impact on small businesses based on research and conjecture. In truth, any additional burden on small businesses will only further impact their ability to play a key role (which has historically been the engine of recovery) in what is becoming an extended and gradual recovery. Except for the large billion-dollar companies, no one is asking the opinion of business. I find this disappointing and risky.

Health care reform is of course an enormous topic. Is there anything else you’d like to say about any aspect of it?
RW: The current focus seems to be on heavy-handed solutions which focus on money and government. In reality, the focus needs to be individual centric, locally managed and competition-based.

Transparency needs to become more than a punch line and web site with generalities. The best role that government can play in health care reform is to come up with common definitions for outcomes performance measurement which can be aligned to local issues, standards of protocol for health IT and minimum levels of performance.

All contents © 2009 All Rights Reserved.

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