All the recent changes to health care in the past few years have shown the U.S. health care system as a kind of Rube Goldberg invention; a costly mismatch of parts that doesn’t necessarily get great results.
The Mid-America Coalition on Health Care in Kansas City, Mo., aims to changes that by bringing together employers, insurers and medical providers to lower costs and potentially improve health. The coalition is one of the oldest health non-profits in the United States, and members include a lot of big Kansas City businesses like Cerner and Hallmark.
Here are five questions answered by Troy Ross, President and CEO of the organization:
Everybody in health care, for a while, had been really watching and looking at the enrollment on the health exchanges. Now that that’s over, I’m wondering: what do you see as the next big thing in health that we’re really going to want to pay attention to?
One of those is, of course, is evaluating the private exchanges. Right now, the majority of large and, I would say, jumbo-sized employers in our market have employer-sponsored health care, where they’re still paying for the majority of health care for their workforces, and one of the challenges they have now is to look at private exchanges - and for some, the public exchanges – but private exchanges in terms of, ‘Does it make sense for us to continue to cover our employees ourselves, or, looking through that business lens, does it makes sense to consider a defined contribution?’ In other words, give them a set amount of money and let the employee and their family go to the private exchange and find health care.
And of those choices, which one do you see employers kind of favoring at this point?
There’s an organization called P.E.E.C., and it stands for the Private Exchange Evaluation Collaborative. It’s an independent third party that is going to help employers navigate and evaluate private exchanges. We are looking at some of the data that has come back from the survey results of that organization, and we are finding that a lot of folks are considering the private exchange. Forty-five percent of responding employers to a survey that was sent out [to] over 727 large jumbo-sized employers in the country as well as mid and small-sized employers said that they are considering utilizing a private exchange for their full-time active employees before 2018. We feel like as a coalition, in this market, we’re uniquely positioned to help our members and our employers in the greater KC metro get educated and help make a more informed decision on whether or not to participate in a private exchange.
I know one of the goals of the coalition is to get employers and providers and insurers to work together. What are the challenges in making that happen?
One of the challenges that the ACA presents is that it doesn’t address probably the driving force behind our continued increase in health care costs in our community, and that is how physicians are paid. And the only way we’re going to resolves that issue is to truly get everyone around the table and address payment reform. Our next step, in about a six to eight week period is to hold Kansas City’s first payment reform summit and bring together steering committee to address payment reform in Kansas City.
Just looking at surveys, as I understand, a lot of physicians are kind of getting discouraged in recent years because of feeling like they are losing some independence, because of the tightening of budgets and things like that. What do you think is going to be needed to get physicians on board with containing costs?
Well I think the first step is we need to have a better understanding, I would say, of how this impacts our provider community or our physicians. You’re right. We’re seeing that approximately, right now in our community, 55 percent of all primary care physicians are on a hospital payroll. And that includes virtually all cardiologists and oncologists. So what that tells us is that it’s become difficult for our provider community to stay in business, so we need to understand what those challenges are. And starting with them; starting with our physicians I think is going to be critical for us to understand payment reform and take next steps.
Another initiative of the coalition I saw is regarding vending machines. What role do those play in public health?
This is a role that we’re been working on to help our employers evaluate the health of food that they have in their vending machines, and is that something that control or maybe do a better job in influencing what is put in those machines for our employees?
