Moving Past Public Options and Health Care Co-ops

| Wed Aug. 19, 2009 11:29 AM EDT

Now that the public option in health care reform seems to be nearing its demise, non-profit co-ops are all the rage, with every damn media outlet in the Union scrambling to pick apart the latest player in the health-care debate. Just as the public option's merits have been debated and fought over ad nauseum, so, too, will this latest twist in the health care battle, an idea largely connected to Sen. Kent Conrad (D-N.D.), a member of the (unfortunately) influential Gang of Six.

But this entire debate, lest we forget, has centered on mainly one aspect of overhauling health care to make it more affordable and expand access to the uninsured. Granted, you wouldn't know that by how much the admittedly sexier insurance side of the discussion—how we get care—dominates the news cycle; but arguably an even more important part of health care reform has been grossly underreported so far—what kind of care we receive. By that I mean the doctors we see (primary care or sub-specialists), the quality and types of care provided (proactive or reactive care; preventing versus doing), the health care systems that administer our care. And if you don't yet believe this subject needs far more attention than it's getting, read what Dr. Eric Larson, MD, MPH, and the executive director of Group Health, one of the leading co-ops in the nation, recently wrote to me. [after the jump.]

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I e-mailed Dr. Larson (who I'd previously interviewed) to ask about his thoughts on this shift to co-ops possibly fulfilling the role of a public option in health care reform legislation. He graciously replied with a long, detailed message, saying he thought the Group Health model could guide discussions among legislators involving co-ops. He also mentioned, however, that it's taken Group Health decades to get to where it is today—an exemplary health care system named the top HMO by Consumer Reports—and the same would surely apply to new co-ops.

But more importantly, Larson strongly emphasized not just Group Health's co-op model but how it chooses to deliver care—namely, its focus on integrative care, care that treats patients from a more holistic perspective and seeks to proactively treat illnesses and diseases rather than reactively. It's a model that, unlike so much of our health care system, emphasizes primary care medicine and preventive care—a proven way to prevent chronic conditions, which are, of course, a major contributor to skyrocketing health costs.

He continues:

Any coverage solution, whether a co-op, a public option, or market reforms, must be combined with policies that will change the way health care is delivered. For example, the movement away from Fee for service reimbursement seems an essential piece of payment reform that should occur with healthcare reform.

We also have been very involved with a topic I believe we discussed—the so called patient centered medical home, an innovation that is probably only possible through payment reform. This model—really a good way of adhering to the principes of good primary care, especially for persons with chronic disease—proved to be quite successful in our analysis of one year results (due to be published next month) and we also communicated our two year results recently at a white house conference hosted by [Director of of the White House Office of Health Reform] Nancy Ann DeParle.

If a leader of one of the best co-ops in the nation is saying delivery of care must be addressed just as much as insurance issues, then maybe we should pay a little more attention. After all, while lawmakers and citizens and experts of all stripes may fight over the need for a public plan (or a co-op option, or whatever), I'd be surprised if all of them wouldn't be gung-ho for reforms proven to lower costs, expand access, and improve care quality—all at the same time.

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