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From Health Forum

Health Care Reform
State’s Evidence
Howard Larkin
Four big questions loom over ambitious state efforts to expand coverage. The answers could shape national health care reform....


...How Do We Make Care More Effective and Efficient?
It’s often said that there’s enough money spent on health care to provide coverage for all, if only it were spent more effectively. Many state reform proposals bank on increased delivery system efficiency and better preventive care to reduce acute care and urgent care costs. Because these strategies require extensive integration of records and services among various providers, hospitals play a central role in executing them.

“It’s not just putting in an electronic record, it’s also putting in the infrastructure in the office that allows you to make use of the electronic record,” says Jennifer Fels, R.N., health resource manager for United Health Alliance, a physician organization in Bennington, Vt., that is setting up a patient registry integrated with facilities at Southwestern Vermont Health Care, a local system. Clinical practices must be completely re-engineered to incorporate evidence-based protocols. For example, databases must be set up to monitor when diabetes patients report blood sugar levels and seek preventive ophthalmic care, and alert providers to contact patients who are not in compliance. Record systems must be accessible among many providers to ensure coordination of care across all settings.

The cost of such infrastructure changes may be much higher than the state anticipates, Grause says. Also, issues such as clinical data ownership, privacy protection and IT standards, as well as how much assistance hospitals may give independent physicians, must be settled.

The role of non-physician providers is among the first measures Pennsylvania is addressing as it prepares for more comprehensive reform legislation next year, says Paula Bussard, senior vice president for policy at the Hospital and Health System Association of Pennsylvania. “The idea is to refine the scope of practice for physicians’ assistants, nurse practitioners and others to improve access to primary care and allow these professionals to practice more up to date with their education and training.” Facility regulations also must be updated to remove restrictions on practice for these providers. Physician groups often have been quite aggressive in resisting expansion of practice scope, but Bussard says they are participating in Pennsylvania’s process.

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