Managed Care - November 2008 - (Page 42)

created a receptivity to their idea of transformation and today there’s probably more than a billion dollars in demonstration projects, both public and private, going on in the United States around the concepts of the medical home. And that’s really cool. MC: It is cool. And I have to admit that when I first heard about this I was very skeptical about the motivation of primary care physicians, even though the concept seemed reasonable. So things are on track for implementing the new model? SEPULVEDA: Those experiments are under way, but this is the United States, and we have a geography and a heterogeneity that create enormous challenges for delivering services of any kind nationally. We’re going to need a variety of models to achieve something like medical homes. We will need creative ideas about how to deliver this model in all of the micro-environments that we have in our country. The experiments are addressing that. They are happening in big cities and rural areas, in open and closed delivery systems, and in Medicare and the private sector. The early results are pretty impressive. We’re extraordinarily excited about it, but it’s a work in progress. MC: I’d like to switch gears a bit and ask, in reforming the health care system, which ideas do you think would be counterproductive? SEPULVEDA: That’s a very interesting question; I’ve never really thought about it that way. Let me start with keeping employers in the game. If we give employers disincentives to offering health care, we will lose the single biggest source of innovation in health care. In the last five or ten years, employers have really engaged the subject of health care out of necessity, and they have brought a lot of talent to bear on many components of our fractured health care system. Employers have been at the forefront of bringing adoption and active engagement around things like measurement, transparency, reporting, and performance. They have been leaders and innovators in wellness and health promotion. Employers were really foundational to managing disabilities in an integrated fashion. And employers have been very innovative in thinking about value-based purchasing and how to design health care insurance in ways in which you don’t cut off your nose to spite your face. If you cut em- ployers out of the game right now, that would be an enormous loss. Why risk not having that kind of creativity involved in helping to solve the nation’s health problems? MC: That would be your advice to the new president? SEPULVEDA: I would also make this point in the following way: Diversity is at the foundation of our culture in America, but diversity cuts both ways, particularly in a place like health care. It can be a strength and it can be a weakness, and we need to focus on the strength of diversity. We need to ensure that there’s an environment where innovation can thrive in all sectors, so that states can innovate, employers can innovate, and all parties can innovate. On the other hand, we don’t want diversity in certain other areas of health care, such as technology standards. With information systems and managing and using all of the data that are needed to support doctors and patients making good decisions, you don’t want diversity. We need standards and consistency. MC: Would you like to add anything else? SEPULVEDA: One last thought about health care reform. Like wellness in terms of unrealistic expectations, I think there are unrealistic expectations about this thing called evidence. We all talk about improving quality, eliminating errors, reducing variability, and reducing cost based on people practicing evidence-based medicine. MC: Right. It’s a big deal now. SEPULVEDA: Yes, but I think evidence is oversold, overstated, and exaggerated in that we have a lot of evidence about how the human biological system works and a lot of evidence about treatments. But we have very little evidence about the behaviors of practitioners and patients and how to take those insights into the real world of practice so that they result in good health and behavior change. We need a better balance in generating evidence about how things can really be made to work in real practice settings and in how care providers and individuals receiving care can interact in ways that allow both to change their behaviors in ways that deliver better outcomes. In the end, that’s what’s really important. MC: Thank you. This has given us quite a bit to think about. SEPULVEDA: Thank you. I’ve enjoyed it. MC 42 MANAGED CARE / NOVEMBER 2008

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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