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During a discussion of the current health care crisis, a group of senior managers representing a cross-section of the health care profession in Florida developed seven principals to change our health care system. The group, assembled by Brian Klepper, PhD, included health plan executives, physician practice managers, disease management professionals, a nurse, a provider network manager, a hospital system managed care coordinator, and practicing and administrative physicians.
"The group came to consensus with startling speed, which suggested that these principles are obvious to the people who work the front lines every day," Klepper says.
1. Universal coverage of basic benefits for everyone so that gaps in the system won’t become large enough to cause it to collapse.
2. Supplemental coverage: Anyone who wants it and can afford it gets as much health care as he or she wants.
3. Private sector management of health systems. This includes financial incentives tied to accountability for performance and innovation.
4. Uniform adoption of evidence-based best practices. Klepper cites Minnesota, where all major health plans agreed on the same best practices for the top 50 conditions. "The results have been a dramatic decrease in variation and improvement in quality and cost," he says. However, Klepper points out that establishing best practices wouldn’t mean forcing practitioners to use them but that practitioners should be accountable for their performance.
5. Publicly available performance information on all practitioners and institutions.
6. Distinguishing between preventable and nonpreventable risks. Nonpreventable risks would include diseases, catastrophes, and genetic defects. The group called for greater individual financial responsibility for preventable risks due to unhealthy lifestyle choices and demand for services beyond protocol, or, as Klepper puts it, "holding consumers’ feet to the fire for their choices."
7. Moving from a single year to multiyear health plan. "A single year doesn’t give you long enough to deploy a program and get a necessary return on your investment in disease management and wellness programs. That takes three to five years," he says.