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Why Join the Coalition

01.27.2010 - Coalition Value

Businesses should join health care coalition
By Brodie Farquhar


January 1, 2010 -- The Wyoming Business Coalition on Health has lined up Craig Barrett, recently retired CEO of Intel, as keynote speaker at the coalition's annual meeting on Jan. 25, 2010 in Casper, at the Ramkota Hotel and Conference Center.

Barrett, now based in Chandler, Ariz., says that top corporate leaders need to invest their personal time, personal resources and the resources of their companies into quality of care improvements and the cost effectiveness of care.

And you don't need to be CEO of a Fortune 500 company to be effective, said Barrett.

"I own a ranch in Montana, and we've got our health care expenditures down to $500 to $1,000 per year," he said. Medical services included electronic records on each employee, and the doctors even do house calls!

For his four-legged employees, that is.

The 45 working horses of the Triple Creek Ranch are well cared for by highly-competitive veterinarians, said Barrett, more so than the competitiveness in the medical community for people.

Barrett readily acknowledged that it is hard for any one company to get the attention of health insurance companies and dicker a better deal - he found that Intel's 95,000 employees couldn't do it. But when he joined forces with other Silicon Valley and Fortune 500 companies, they could do just that.

Businesses have to band together in coalitions, said Barrett, without waiting for the government to demand change first. Once such coalitions reach critical mass, they can negotiate meaningful change, he added.


Pay for performance

Barrett finds fault with the dominant economic model in health care service - fees for services - and notes that most doctors get paid for "trying" to make or keep their patients well, not for the end result of wellness.

He pointed out that doctors get paid for prescriptions, for surgeries, for procedures, creating incentives to write more prescriptions, do more surgeries, perform more procedures, even when they don't necessarily add up to a healthy patient.

"I would have loved it if Intel customers had paid us for 'trying' to make computer chips that work," said Barrett, but customers only pay for chips that work and meet their needs. That isn't usually the case with medical procedures, he noted.

It doesn't have to be that way, Barrett said, praising such integrated health care providers as Kaiser Permanente, where payment is based on outcome. Accordingly, Kaiser is focused on the patient, rather than billable prescriptions and procedures.

Barrett is dismissive of health "reform" efforts in Washington, D.C. - something he terms a fight over "who pays, how to pay and how to get the uninsured covered." Barrett termed the current battle in Congress "a balloon squeeze" that shifts costs, but has little to do with modernizing health care or reducing costs.



Call for services?

"How long have we had the telephone?" Barrett asks. It turns out that Alexander Graham Bell invented the telephone way back in 1875, yet even today, Medicare won't reimburse health care delivered via the telephone, "unless the patient is an astronaut, a prisoner or a soldier," said Barrett. Ironically, the Veterans' Affairs hospitals and physicians make extensive use of telephone and Internet connections for remote diagnosis and health monitoring, but not in a fraud-phobic Medicare system.

"As if there isn't fraud in the system now," said Barrett, where the federal government made $98 billion in questionable payments to contractors and individuals last year. Health care delivered via the telephone or Internet creates a searchable, digital record, he noted, which can be searched by computer algorithms that can point investigators in the right direction.

Electronic prescriptions could cut deaths due to medical error, he added, cutting into mistakes caused by poor physician penmanship or reader mistakes on dosage. Tied into a patient's medical record, a computer program could sound the alarm if it found dangerous combinations of drugs.



Cutting costs important

"If simple things like these can't happen, then hope for reform is ridiculous," he said. Trained as an engineer, Barrett looks at the health care industry as bimodal, in that 80 percent of the costs are focused on 20 percent of the population - the elderly nearing the end of life, or the chronically ill. "We can't affect health costs until we pay attention to this," he said.

If Barrett were in charge of triaging the nation's medical care system, he would focus on the elderly and chronically ill, while expanding preventive care for the healthy 80 percent, so as to lower the number of chronically ill (diabetes, obesity, substance abuse, etc.).



Wyoming Business Report Managing Editor Brodie Farquhar can be reached at brodief@wyoming.com or 307 333-4024.

Businesses Should Join Health Care Coalition