For Immediate Release

For more information, contact:
David Kanihan, 612-262-4986

More access isn't enough
Reform must include health promotion, oversight board, simplification

 03/16/2009-- The following commentary by Allina Hospitals & Clinics Chief Executive Officer Richard Pettingill was published in Crane's Modern Healthcare Magazine and at ModernHealthcare.com on March 16, 2009.

How is it possible to have some of the most advanced medical technology in the world just blocks from a local resident who recently explained his health status to me by saying, "I know I'm not dead, but I'm not certain I am alive?"

Thanks to the president's pledge of health care reform, this is a unique time in American history to change a broken health system.

America can no longer afford to spend more than twice as much on health care compared with other developed countries. If our outcomes were twice as good, it might be worth it, but they are not. Over the next 10 years we will have to care for more uninsured people, more elderly and more chronic disease and obesity, leading to greater morbidity and mortality. The current system cannot bear this burden. The risks are too great to squander this opportunity to design a new health system.

There is no silver bullet for reform, but we must start somewhere; we cannot let the magnitude of the problem paralyze us. Let me suggest six areas of initial focus:

• Health promotion. Studies suggest that access to health care improves health 10 percent of the time. Personal health behaviors, environmental factors and genetics impact 90 percent of health status. Simply, the individual—not the physician—has the greatest opportunity to improve health. Despite this fact, Americans invest nearly 90 percent of health care resources on access and fewer than 10 percent on health promotion. It is time to turn this equation upside down. By giving individuals and employers incentives and tools to actively manage their own health or that of their employed population, there will be both an economic and quality of life return on investment.
• Chronic-disease management. Chronic disease accounts for more than 75 percent of all health care expenditures. We must reward providers who effectively manage chronic disease, preventing costly complications and hospitalizations. We also need a payment system that supports care teams (physician, nurse practitioner, nutritionist, pharmacist, etc.) to partner with patients to co-manage the total health of an individual. If health promotion does not help us reduce the prevalence of chronic disease, at least we can manage resources more wisely.
• Electronic connectivity. By 2014, implement a uniform electronic health record that is as portable as an ATM card. Every American should have complete access to his or her personal health record at any time and in any place. Funding should support electronic connectivity in order to focus on prevention and chronic-disease management.
• Administrative simplification. It is estimated that more than 30 percent of every dollar spent on health care is to cover the cost of administering the system. That's $320 billion that could be spent more wisely. Most developed countries spend substantially less on administering the system. We need to appoint a national leader with the accountability and authority to standardize administrative processes and eliminate wasteful bureaucracy.
• Universal access. Ensure all Americans have access to health care. Provide a minimum benefit set and catastrophic coverage for children and underserved populations. A standard benefit set should be designed with a bias toward preventive and chronic care.
• Governance. Explore new models of independent governance with the goal of providing the strong strategic direction and policy oversight of the American health system. Americans distrust a government-administered health system. One model is to create a public-private structure similar to the Federal Reserve Bank.

Is it possible to fix our broken health care system? Last summer, the Allina Hospitals & Clinics board of directors committed to invest $50 million over five years in a new enterprise, the Center for Healthcare Innovation, aimed at doing just this.

• The Heart of New Ulm: Through a community-based project, we aim to understand the total cardiac risk for residents of New Ulm, Minn., and implement interventions to reduce, and eventually eliminate, that risk.
• The Backyard Initiative: A second effort in Allina's "backyard" — the neighborhoods around Abbott Northwestern Hospital and Midtown Exchange that are part of the paradox I see everyday — aims to partner with the community in innovative ways to improve the health and well-being of an underserved population. We'll take what we learn and share it to improve health and reform the system.

We're making this investment because we believe that our organization must be part of the health care reform solution. However, one organization can only do so much. We need leadership from our government and citizens at all levels to take bold actions, such as those above.

Michelangelo said, "The greatest danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it."

Now is the time for bold and inspirational leadership. Let's not miss this historic opportunity to make the difficult choices that will improve the health of future generations. Although there are compelling economic reasons to advance this agenda, it is our American values that demand bold action to ensure all have access to a world-class health system.