The Free Press, Mankato, MN

November 22, 2012

Spear column: Entering health care’s new world

By Joe Spear
Free Press managing editor

— Doctors will be paid differently, patient relationships will change and business as usual will be disrupted.

Those are just some of the challenges facing us in the brave new world of health care coming our way sooner than later. Many of these changes are systematic and cultural and will be required if we want to maintain the quality of care, improve access and pay for the growth in demand.

The assessment of the brave new world comes after listening to local leaders in health care. At least once a year, The Free Press Editorial Board meets with leaders at the Mayo Clinic Health System, Mankato, including CEO Greg Kutcher, Chief Administrative Officer Rich Grace and Public Affairs Director Kevin Burns.

Connected to the world renowned Mayo Clinic system, these leaders have insight into the future as their organization attempts to embrace the changes, stepping cautiously and with due time.

The brave new world certainly is different but not necessarily bad. Change is necessary in all systems but particularly needed in health care as demand will skyrocket and resources to serve that demand will remain flat or decline. That would be a huge challenge for any industry, much less one people are emotionally connected to by family and friends and their very own mortality.

Kutcher notes we have to move from a “disease management” system to a true “health care” system, one that prevents diseases from happening instead of treating them like a product in demand.

Cost of care continues to be the big issue. And while prevention is something everyone should be embracing, it alone will not make a significant dent in the cost of health care, according to Kutcher. That must come with better management of complicated diseases that now consume 70 percent of the cost. Most of those diseases are managed in a population that is over 65 years old.

Some of the cost comes from end-of-life care and some that can be extraordinary. To that end, Mayo and others are helping patients with serious health problems and their families understand and discuss all the options.

That’s also where the palliative care team comes in. The general public tends to associate the term palliative care with end of life or pre-hospice scenarios, but it can just as easily be applied to a serious but curable disease.

The palliative care team is a collection of professionals including doctors, nurses, social workers and even spiritual counselors. It aims to relieve patients of the symptoms, stress and pain of serious illness. While this kind of care gets no real government reimbursements, systems like Mayo are doing it because patients find it more satisfying and health care organizations may be able to lower costs.

(Medicare does pay for hospice, but only after doctors have certified you will likely have 6 months or less to live).

In fact, some results of the palliative care show people live longer and are happier with the time they do have. It’s better care at lower cost. “It’s not even about dying, it’s about making better decisions,” says Kutcher.

Of course, this is where the big cultural change hits patients and maybe no so surprisingly some of the medical professionals themselves. They’re trained to fix things, and to solve problems, so they are sometimes not tuned into the options that families might find more comfortable regards a loved one’s care in serious illness.

The health care providers can cite numerous examples where family members disagree about end of life care because their loved one did on leave an advanced directive.

Grace sees a big change for consumers when the new health care law takes full effect in 2014. He sees some employers dropping their coverage and more and more people going to health care exchanges. That will require a huge learning curve on their part to understand not only transparency in pricing but what different coverages will offer. These are complex details once managed by the human resources departments of most companies.

Health care exchanges and reform will likely impact providers. Kutcher says they’ll get paid less from government programs and may eventually have to move to taking care of “populations” not individuals. Government pay programs and even commercial insurers may move toward paying based on how healthy a provider can keep an entire patient “population.”

He says providers who have the right strategies like preventive care and patient management will have to go faster now to move toward reforms. They will need to examine duties of doctors, nurses and even website roles in providing patient care and information. Nurses may do things doctors once did. A website may be a source of information instead of a doctor visit.

Physicians may eventually be responsible to the health care team in treating patients versus simply answering to the patient. That will certainly be a big change for the physician and health care culture.

These changes are now a question of “when” instead of “if.” And the when is getting a lot closer. From a health care consumer perspective, we should be ready to listen to the changes, see if they make sense. Most will be driven based on efficiency and quality of care and the two are not mutually exclusive.

We should be willing to change our health care consuming habits if they are habits of convenience versus  habits of necessity. Our system has some of the best providers, but the costs are ready to smother patients, reduce access and create a fiscal typhoon if we don’t act.

Part of health care reform that sometimes gets lost in the emotional arguments was aimed at spreading out the risk and cost by including everyone in the system, especially healthy people. But even that bigger pool won’t by itself get costs to where we need them. There needs to be systematic changes.

We should not lose sight of that. That means health care providers and patients will have to move out of their comfort zones.


Joe Spear is editor of The Free Press. Contact him at 344-6382 or