DOTmed attended day one of last week's World Health Congress in Washington, D.C., a meeting of about 1,400 opinion leaders from the public and private sectors including health plan executives and payors, employers, and government and military administrators.

The event combined a strategic orientation with some breakouts that drilled down to programs and solutions that might be replicated in health care reform efforts. A few officials from the executive branch attended but provided scant insight into the direction that the Obama Administration favors in health care reform.

Dora L. Hughes, M.D., M.P.H., Counselor for Public Health & Science for the U.S. Department of Health and Human Services gave the opening keynote address.

"We are convinced this will be the year we get health care reform done," Dr. Hughes said. "Rising health care costs represent the greatest challenge to our long-term viability." She quoted the President as saying, in the recent White House Healthcare Forum that the question is not whether every American deserves health care coverage, the question is how to provide it.

Dr. Hughes listed recent health care investments and priorities of the new Administration including CHIP reauthorization, health IT, comparative effectiveness research, prevention, community health, and federal workers programs. In terms of a blueprint for policy direction, Dr. Hughes stressed the need for payment accuracy in Medicare and Medicaid as well as pay for performance to improve care and constrain costs.

While no plan for health care reform is yet written, she said that the Administration will take a collaborative approach guided by eight principles including protecting family health, affordability, prevention, quality/safety, portability, choice of doctors, ending ineligibility due to pre-existing conditions, and reducing costs. Notably she did not list universal coverage as among the guiding principles. She did suggest that the President advocates for a public plan but said they are working with Congress and, if the eight principles are met, the President would not oppose a bill solely on the basis of it not being a public sector solution to U.S. health care reform. Reading between the lines, as attendees no doubt tried to do, this left the door open to a private market approach.

A poll of the audience, evenly split between Democrats and Republicans, revealed that 56 percent think the Obama Administration will enact health care reform this year. Forty-four percent do not think so.

Regardless of the degree of confidence or concern over a federal health plan, most speakers and presenters agreed that employers' burden in paying for health insurance is largely to blame for the current U.S. economic crisis.

Conservative Perspective

The other side of the aisle was well represented with high-profile speakers including Newt Gingrich, former Speaker of the House of Representatives and Founder of the Center for Health Transformation; and Mark McClellan, M.D., former CMS Administrator and FDA Commissioner, and currently Director of the Engelberg Center for Health Care Reform at the Brookings Institution.

Describing health care as a challenge and opportunity, Dr. McClellan said, "Growth in health care can be an engine or an anchor." He said that some health care spending has led to great value but persistent problems include inefficiency, overuse as well as underuse and misuse, medical errors and variation in costs. "We need short-term investment and long-term change," he said.

Dr. McClellan pointed out a chronic problem in government administration of any program when he said, "Under the current system, you are paid less for better care." This refers to the way bureaucracies operate by paying for services, actions, or activities, rather than providing incentives. He recommended we measure quality and cost using patient-level outcomes, instill accountability and build a process away from the fee-for-service model now in place. "Instead of paying more for more costs, how about paying more for better care?" he said.

Regarding the ideology that will guide reform he said, "My hope is we don't sidetrack the health care reform debate on this one issue of public versus private [plan design]." He added, "People trust doctors, not the government or insurers to make decisions."

Mr. Gingrich, while optimistic about the outcome, warned that "self-protection of people who don't want change" will present impediments to reform. He acknowledged that the requirement for electronic health records was "one of the few positive things" in the stimulus bill. But, he said, "My biggest fear is if the stimulus is spent the wrong way it will freeze technology at an immature point."

He noted, "Government bureaucracy is antithetical to entrepreneurial solutions" and advocated for a "decentralized structure with breathing room for entrepreneurs to solve local problems."

Some themes that kept recurring during the conference were the possibility of regionally organized health care delivery, individual patient responsibility for health, the important role of allied health providers, and the concept of the medical home.

Health IT was also a focus in many sessions since private insurers and regulators are struggling to implement EMR quickly, yet with the needed interoperability to allow data to be shared among organizations and physicians. Several attendees expressed concern that such a synthesis will be difficult given the fractured nature of U.S. health care and the multitude of software and IT vendors. Adding to the challenge is the politics not just of determining the government's role in the U.S. health system, but the local politics of competition among hospitals, which discourages system compatibility.

A small, diverse group of exhibitors included pharmaceutical companies, claims and medical management firms, health IT software vendors, consultants and other resource providers.

Watch DOTmed News for further reporting coming out of this meeting.
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