Skip Navigation
Health Care Crisis in Sonoma County, a campus-community initiative and dialogue at SSU

 

Transcripts and Easel Notes from Spring 2004 Conference

After-Conference Easel Notes
from Saturday, April 24, 2004
Transcription of notes by Jeremy Nelson 4-26-04

Group A: Building together a Sonoma County coalition to moderate costs and improve care

Ideas expressed by members of Group A:

  1. Lower costs-Maintain Costs-Control Costs
  2. While improving Quality
  3. Seek affordable care for working people
  4. Lower costs
    • Provider required care
    • Utilize appropriate medications
    • Do only necessary surgeries ("cut" the unnecessary)
  5. Partnering with their purchasers
    • County
    • School
    • City workers
    • Chamber
    • Labor unions
    • Large/Small employers

Problem Solution suggested by Group A:

  1. Need executive leadership to be involved
  2. Bring in powerful associates
  3. Establish a model in Sonoma county
    • Identify problems
    • Seek PERS as partner
  4. Two biggest problems with costs are
    • Hospitals
    • Pharmaceuticals

Opportunity identified by Group A:

  1. Building a model for Sonoma County - including all residents
    • Challenge how basics are done:
      • Acute care
      • Chronic care
      • Prevention
      • Hospice
    • Involve PERS in serious dialogue/ potentially as partner
    • Study purchasing system
    • Combine large populations
    • Improve grades K-12 and grades 13-24 in approaches to education on health care
    • Study individuals' participants (and excludeds') thoughts and actions
    • Consider alternative providers
    • Develop legal and regulatory structure; work to reflect participants' values
    • Consider needs of those who don't work, can't work- involve them in studying what is needed
  2. Solve whole problem with single payer?
    • Serve the underserved
    • Consider whether plan(s) should be for the working or also for the not working (all residents)
  3. Economic and political principles may be different (Calls for potentially different roles and approaches) for:
    • Acute
    • Chronic
    • Preventive
    • Hospice
  4. Governments (public jurisdictions) among purchasers to be included in the coalition
  5. Consider payors attached to Medicare, MediCal, District hospitals
    • All could be involved/included
  6. Can this be a "Virtual" single payor? How should this be defined?
  7. Let's call into being a hypothetical health care "trust" in Sonoma County- including local hospital districts, local IPA's
    • Use local service talent in collaboration
  8. Develop a system where valid economics are aligned
  9. Single payor effect if all just paid the same prices (Stop outrages)
  10. Increase transparency and effectiveness of information flow through efficiency of Information Technology (IT)
  11. History
    • '92 county voted housing funds by using 1 cent per hour per county employee
    • Thus consider aggregate funding
    • Create grants?
    • Support "trust" idea
  12. Further support for X cent per hour idea
  13. The issue of "tax" raises business flag - Instead of raising opposition, be sure to take the time to get all people behind it.
  14. If this process waits for absolutely everyone to get on board, the train will never leave the station. Gather those sectors of the county who want to move - and move forward
  15. Mix of publicly accountable individuals
  16. Need a structure which is all inclusive for Sonoma County
  17. Target getting things done
    • Design together the move ahead
  18. Next step
    • GET STARTED WITH THOSE WHO WANT TO BE IN COALITION
    • AGAIN, for emphasis, GET STARTED
    • AUSPICES? CONVENOR? MOTHER SHIP? TEMPORARY CONVENOR?
    • Dates for deadlines or goals?
    • Who's in?
    • Who should be in?
    • Who has resources to work?
      • United way
      • Begin with SSU convening next dialogue
      • SSU and invite UW
      • Community Foundation of Sonoma County
      • Codding Foundation - Connie Codding
      • One structure: Michael, Geza, Norm, Bob
      • Condensation of these suggestions - out soon
      • Skip with Bob ideas
      • Skip with Art ideas
      • Volunteers for subcommittees
      • County wide representation

Groups B/C: Chief barriers and how to overcome them + Highest priority health care activities to consider

Barriers identified by Groups B/C:

  1. Communication resources- cooperation
  2. Assumptions and pre-conceptions
    • Must stay open and flexible to ideas
  3. We can't stop providing while planning
    • Impossible to plan and implement at the same time?
  4. Unclear at responsibilities and quality
    • When do you have second opinion?
    • More education needed
  5. Lack of trust between employer and insurance companies
    • Without trust you can't progress
  6. People in charges of healthcare providers need to become more educated, since many don't have healthcare background
  7. Lack of understanding as to where $ is going
  8. Difficult to build and easy to lose trust
  9. Tech is priority and field is losing touch with importance of care
  10. Dr.'s need to re-learn bedside manner
  11. Lack of incentives to collaboration and treatment and prevention
  12. Lack of freedoms
  13. Too much secrecy
    • What are other counties' plans doing/paying?
  14. Competitive nature (vs. collaboration)
  15. Tech lag of info
  16. Lack of choice in transferring info.
  17. Many people don't have health care
    • Maybe gov't should reinsure high risk patients
  18. Lack of strategic planning for where to allocate resources

Possible solutions suggested by Groups B/C:

  1. mediation between insurance providers and patient advocates
    • Objective, impartial peer group could mediate
  2. more transparency of where funds are going (SCC and financial)
    • See all layers involved
    • What are all the "hoops of accessibility"
    • Rewards for preventative actions
  3. Incentive to collaborate
    • Ins. Covers weight loss and smoking cessation programs.
    • collaboration incentives among cost and providers.
  4. Smoother flow of referrals and getting to where you want or need to go (specialist to see)
  5. Coming to terms with complexity and how difficult to mediate
  6. Major attitude change
    • Profit must not be #1
    • Better bedside manner
      • Legislate possibilities
      • Youngsters mentoring youngsters
      • Educational sus.
      • Networking among community
    • Bringing together different groups
    • Neutral party to bring the pieces together
      • Providers, carriers, consumers
  7. More transparency at how much things cost and what pros are paid
  8. Incentives for curing people faster as opposed to financially being penalized
  9. Educate younger generation and motivate them to want to be in the field
    • Could also motivate displaced pros from other fields.
  10. Prog. at how to take care of yourself in health care field

Ways to improve care - reduce costs

  1. Rationing of healthcare
    • Limit to what we are willing to do with terminology and technology
  2. Address issue that 80% of ill patients health care costs may be in the last year of life
  3. Invest in prevention
    • Lets do more at biggest causes of fatalities on a preventive level
  4. Incentivize people to educate themselves when they are healthy and young
  5. Rationing or pooling resources among hospitals (e.g. Kaiser working with Sutter)
    • Limits to tech (MRI) or hospitals
  6. Re- evaluate system
    • Managed care - managed competition

What Works?

First list Second list Third list
  1. Free enterprise
    • Competition
    • Entrepreneurship
    • Choice
  2. Communicating between conflicting interests
  3. Dedicated health care Profs
  4. Quality health care
  5. Collaboration between profs and plans
  6. Educated and knowledgeable brokers committed to consumers
  1. On surface, getting taken care of
  2. Health care trusts, coalitions
  3. Have insurance, for most part
  4. Health care industry doing some things right
  5. Preventative health care can work
  6. Employers still willing to pay for health
  7. Motivates staying employed
  8. Group ratings- strength in #'s
  9. Blending of rates with retirees
  10. Shared decisions- making process
    • Labor-management, intra union, networking
  11. Kaiser works
  12. Integrated systems work
  13. People more educated consumers of health care and insurance
  14. Socialized medicine works
  15. Full coordinated participation by doctors, plans, workers
  16. Large populations work
  17. Good working conditions mean lower medical care utilizations
  18. Public health care systems work
  19. Education of members works
    • Community
    • Employers
  20. Raises work
  21. Employers resource work
  22. Benefits in lieu of compensation work
  23. Cost- containment measures work
  24. Group purchasing works
  25. Choice of generic vs. name brand works
  26. Personal relationship with providers works
  27. Simple claims procedures
  28. Mandatory 2nd opinion - peer review
  1. Medicare
  2. Strong primary care infrastructure
  3. Community support of hospital funding
    • Taxes approved
  4. Community hospitals responsive to community needs
  5. Secondary and tertiary care providers excellent
  6. Kaiser succeeding here - a model (plus excellent marketing)
  7. One stop shopping (Kaiser) physician, pharmacy, psychotherapist
  8. Health technology
    • Improvements cutting edge and world class
    • Demographic data accessible
    • Preventative care and access to same
    • Federally qualified health centers and rural care facilities
    • Purchasers (CALPERS) challenging provider (Sutter)
    • Sonoma County environment conducive to activity/ exercise

 

What doesn't work?

First List Second List
  1. People falling through the cracks
  2. Too much finger pointing
  3. Technology for data collection isn't available
  4. Overutilization of helicopters/ ground transportation problems
  5. Lack of integration of technology and data
    • No good communication
  6. Unnecessary med care/ lack of wellness programs
  7. Health care info is fragmented
  8. Undocumented workers and the care
    • Lack of coordination of care
    • Lack of treatment with dignity and humanity
    • Seeking care from wrong venues
  9. Lack of cross-collaboration between stakeholders
  10. Providers don't have enough time
  11. Disconnect between consumer expectations and systems ability to deliver
  1. Gatekeepers
  2. Unscrupulous brokers
  3. For-profit hospitals
  4. Corporate health care
  5. Uncaring people
  6. Link of health care to employment
  7. Closed-minded employers
  8. JPAs (phony without labor representation)
  9. Lack of choice
  10. "Black box" actuaries- no data
  11. Non-medical oversight of medical issues
  12. Inequitable access to care among groups
  13. High co-pays for low-income workers
  14. Lack of education of employees
  15. Pharmaceuticals industry out of control
  16. Hospitalization costs
  17. Inadequate medical reimbursement
  18. Malpractice insurance
  19. Inadequate reimbursement for some docs
  20. Excessive reimbursement of some others
  21. Excessive "specialties"
  22. Cash in
  23. Cost shifting doesn't work
  24. All things that "work" don't work well enough so everyone benefits
  25. Prozac
  26. Drug industry setting agenda for meds
Third List Fourth List
  1. Million people without health care
  2. "Emergency room" health coverage at 10X's the price
  3. Inability to get appointment
  4. Overuse of antibiotics
  5. JPAs again
  6. Bean counters designing health plans
  1. Defensive medical procedures used to avoid liability and stigma of incompetence
  2. Spending 50% of healthcare $$ in last six month of life
  3. Highest rate for cancer care in Sonoma County, higher than anywhere else in US
  4. Health plans require subsidizing by patients because hip not providing funding
  5. Poor distribution of physicians
  6. Kaiser customer satisfaction
  7. Gap in health care. costs between healthNet and Kaiser resulting in drop in school district personnel subscriptions
  8. Explosion of technology has not generally improved health care quality - dualized and inequitable care by income and race. Etc.
  9. Aging population
  10. County does not generate demographic data; all comes from outside agencies
  11. Resistance to looking at problem of health care - fear of disease and mortality.
  12. No employer in Sonoma County who will challenge higher $$ very successfully
  13. Sonoma County cost of living
  14. Limited access to mental health care providers
    • Found therapist via flyer in coffee shop
  15. Communication between provider professional groups - also insularity and disdain re: other health care options
  16. Physicians pay for treating California poor in contrast to pay in other states
  17. Prescribing meds in excess of common needs
  18. Health systems income too high
  19. Public health programs patient mgmt compared to other counties

What needs to change?

  1. Large and small employers need to be here at meetings
  2. Needs assessment and marketing needed to get them involved
  3. Large employers share discounted rates with smaller
  4. Health organizations working better with each other
  5. Price increases in county
  6. Pharmaceuticals costs
  7. Wasting resources by overusing procedures in order to recoup costs of technology
  8. Demographic data for Sonoma County needed to better understand health care population and needs
  9. Higher co-pays that discourage poor from using care
  10. Better relationships between providers and consumers
  11. Cutting back on # of specialists compared to primary care physicians to combat "illegal cartels"
  12. Collaboration between groups; Medicaid steering process for instance
  13. Eliminate egos! Parochial thinking
  14. Know better and predict better payor rates to manage clinics, care centers proactively
  15. Freedom to treat as I want to but can avoid huge fluctuations in accounts receivable
  16. Developing third system that is amalgam of exiting options
  17. Outcome measurements needed answering questions "why we are doing what we are doing"
  18. ROI analysis needed to begin planning changes
  19. More providers need to be in our conversation
  20. Accessible, user friendly data that consolidates info

What do you want to do about it?

First List Second List
  1. Solve technology and data problems
  2. Give providers/consumers info they need
    • Use technology to their advantage
  3. Standardized claims processing
    • EOB's, bills, etc.
  4. Standardized authorization protocol
  5. Empower the consumer to make informed economic health care decisions
  6. Promote fair and equitable competition
  7. Encourage dialogue between stakeholders
  8. Affordable housing for health care workers
  9. Better outreach to undocumented workers
  10. More community clinics
  11. Provide incentives to motivate people to use wellness and disease mgmt. programs.
  1. No JPAs
  2. Ethics test for brokers
  3. Pooling of resources
  4. Purchasers' coalition
  5. Shared decision-making
  6. Brokers paid by group satisfaction and medical outcomes
  7. Manage workplace stress
  8. Improved mental health services, not pill pushers
  9. Ergonomic standards
  10. Incentives to promote lifestyle changes
  11. Improve elderly retiree care
  12. Financial support for home healthcare
  13. Scholarships for healthcare professionals
  14. Receiving care in home rather than in hospital
  15. Knitting
  16. Regulation of fees
    • Mandatory audits of health industry (plans and providers)
  17. Universal access
  18. Increase # of providers
  19. Educate to reduce use of antibiotics
  20. Radical redesign of system
    • Educating school children to be effective consumers of health care

Final Summary of group B/C:

  1. Collaboration, mediation, and possible oversight
  2. Education and information-sharing, including on prevention
  3. More use of incentives for cost-effective approaches, life style changes and sharing resources and pursuing health care careers.
  4. Re-evaluation of system including rationing measures
  5. Cultural paradigm-shift lifelong includes media and education
 
contact us | | 1801 East Cotati Ave., Rohnert Park, CA 94928
last updated May 10, 2004