KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Industry Leaders Offer Solutions For Health Care Reform

The Chicago Tribune published a series of articles on industry's solutions for health care reform. The paper "turned to Chicago-area leaders in three key segments of the industry: insurers, medical providers and pharmacy," and presented their "thoughts on how best to expand medical-care coverage to all Americans."

Pharmacists: "By helping patients make better choices, pharmacists say they can help save billions." But for "medication therapy management" to be effective, they'll need higher payments. This article was highlighted in yesterday's edition of the Kaiser Daily Report.

Insurers: Blue Cross and Blue Shield of Illinois president Paul Boulis says that for a health care expansion to be successful, "all consumers need to be enrolled in a plan." Without a mandate, "consumers could defer getting coverage until they need medical care, and that can lead to higher premium costs for those with insurance." Mandated coverage allows insurers to "spread the risk" and provides them with a larger pool of money to help them pay for claims, which "helps them turn a profit and provide benefits and services to more people." Boulis says the recession has been bad for business. "For the first time in a quarter century," Blue Cross and Blue Shield expects enrollment to drop this year. A mandate would "get everybody under the umbrella," Boulis says, but he says that doesn't necessarily mean costs will level off. "He worries about the millions of people who may have been avoiding the doctor's office or ignoring their ailments flocking to the health-care system. 'A good portion of those people are going to have myriad problems,' he said. 'You are going to have to be very savvy about what you cover.'" But numerous health plans, including Blue Cross, has told Congress they "would not reject coverage for consumers with pre-existing medical conditions" if a mandate is included in the overhaul.

Doctors: For health reform to be effective, doctors in small practices must get "funds and support to equip their offices with the latest technology and quality data," says Dr. Lee Sacks, the "top administrative physician at the largest provider of medical care in Chicago." "Most Americans receive their care from practices of fewer than five doctors," and those doctors complain of "lack of infrastructure to effectively address future patient needs." Sacks' provider organization, Advocate Health Care, lends "resources to the more than 3,200 independent doctors, largely in small practices" who are trying to improve their quality of care. He says that organizing small practices is needed to "effectively implement health-care reform that is high-quality and cost-effective." Some of the assistance, Sacks says, "is coaching and training, and some of that is infrastructure, data and feedback," including electronic health records. He expects additional money will be needed to "offset the additional coverage" (Japsen, 6/4).

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