By Brian E. Clark
For WisBusiness.com
MADISON – Wisconsin has long been considered a leader in providing quality health care for most of its residents.
But a panel of experts said Tuesday that the state has a ways to go when it comes to controlling medical costs. Over the past decade, health insurance rates in the Badger State have risen faster than the national average.
Speaking Tuesday morning at the annual Wisconsin Women’s Health Foundation Dialogue, the panelists said physicians groups, insurers, employers hospitals and individuals bear responsibility for holding down the rising cost of health care.
“Our current system is not sustainable,” said Nino Amato, the panel moderator and a former executive at Meriter Health Services. “We need to ‘bend’ our cost curve and reduce expenditures while maintaining our national reputation for health care quality.”
Larry Pheifer, executive director of the Wisconsin Academy of Family Physicians, said studies have shown that having primary care doctors – rather than specialists – handle more patients could cut a third from current costs.
But he said pay for family care doctors should be increased and argued that those pay hikes could be covered if preventative programs were more successful in keeping people from getting ill.
He also said the country needs many more primary care docs and argued that costs could be contained by using more advanced-practice nurses in clinics that he dubbed “patient care medical homes.”
Jo Musser, vice president of the Wisconsin Health Information Organization and a former state insurance commissioner, said a data-gathering effort by her group is providing information on how medical dollars are spent.
“Consumers need information and this is providing it,” said Musser, who was insurance commissioner under former Gov. Tommy Thompson.
By gathering information on millions of insurance claims, WHIO is able to measure quality, efficiency and effectiveness, she said.
“This isn’t perfect, but it’s better than anything to date,” explained Musser, who said the data gives physicians and hospitals information on how they can compete with each other.
In addition, it allows medical groups to better monitor to the performance of their doctors, she said, noting that one central Wisconsin hospital was reviewing its procedures after WHIO data showed it had a 46 percent higher readmission rate than a nearby facility.
Because the patients had to re-enter the hospital, hundreds of thousands more dollars had to be spent on their care.
In addition, she said, the WHIO data will be used by the state on its medical plans to achieve cost savings.
Douglas Reding, a Marshfield Clinic oncologist and vice president, said reforms at the central Wisconsin facility are helping saving money, improve access and improve quality.
But he warned that a small number of chronically ill patients use the vast majority of dollars spent on health care. In Medicare, for example, 25 percent of beneficiaries use 85 percent of the resources.
And Cheryl DeMars, CEO of The Alliance, said her south central Wisconsin employer group wants to reduce medical costs to members by “working on the underlying causes, not shifting costs to employees.”
By using cost and quality data, which she said takes “digging and analysis,” her group found that the cost for the normal delivery of a baby ranged from $3,045 to $8,960 for Alliance members.
The group also learned that there were significant differences in the number of expensive C-sections performed on low-risk mothers at different hospitals in the same communities.
“We should require health care plans and networks to align reimbursements with results,” she said. “Unfortunately, that is not done now.”
She also said companies need to spend more time promoting wellness and changing workplace and community cultures to help make workers healthier.
“Finally,” she said. “We can’t be satisfied. Wisconsin may be No. 1 or No. 2 in health care. But we are celebrating a score of 80 percent when we should be working for 100 percent. To do that, we have to hold health care vendors and suppliers accountable.”
State Sen. Mark Miller, D-Monona and co-chair of the Legislature’s Joint Finance Committee, also spoke at the conference and stressed the need for dental care to be included in any kind of reform efforts.
Pheifer, of the Family Physicians group, said some primary care doctors are in practices – which he called medical “neighborhoods” – that include dental care.
Similarly, Chris Queram, head of the Wisconsin Collaborative for Healthcare Quality said the state needs “holistic” health care that includes dental coverage.
Other panelists said dental care for children in Dane County is the number one reason for absenteeism by school children. But they noted there’s also a shortage of dentists in the state.
The panelists also touched on the need for mental health care coverage because psychological problems can worsen any health condition. DeMars agreed that mental health should be covered, but said “comparative effectiveness research is badly needed.
“Employers want to know what works,” she said. “Paying for anything and everything is not the answer.”
Because Wisconsin is facing a $2.7 billion deficit, Miller said the state’s ability to fund any new initiatives is extremely limited.
“New money is not there,” he said. “The challenge is to be more efficient. We have to face fiscal realities and we can’t rob K-12 education to pay for new projects.
“”Health care reform won’t happen instantly,” he added. “We must digest federal law changes and look at pilot programs to move toward more efficiencies.”
