Commentary on White House Summit

How Should Colorado Lead?

By Michael Salem, MD, President & CEO
    National Jewish Health

During last week's healthcare summit at the White House, President Obama laid out his goals for comprehensive healthcare reform this year: providing health coverage for all Americans; substantially lowering healthcare costs; focusing on preventive medicine; and, improving the quality of care delivered.  A herculean legislative task in a short time frame.

What was clear from attending the forum - from the initial speeches, the breakout sessions, and the wrap-up was the overwhelming bipartisan firepower in terms of Congressional support for the process. Many who led the opposition to the 1993 healthcare reform efforts spoke in support of the "restarted process".

Colorado should have a strong voice in the debate and lead in health reform solutions. Some ideas were already detailed in the 2007 Blue ribbon Commission on Healthcare reform. Our efforts will require substantial support from our Governor, Congressional Delegation, and our State Legislators.

Though we look forward to federal funding from the stimulus package for the implementation of electronic medical records, we believe that additional investments in healthcare information technology infrastructure will need to be made.  At National Jewish Health, we are bringing together the information on what diseases a patient may be pre-disposed to, all laboratory, imaging and pathology tests the patient has had, as well as the latest therapies available and how the patient might respond as well as managing their disease after they go home. This information is available today, but it requires significant investments in healthcare information technology computing power to bring it all together.

We currently have too few primary care professionals and centers where preventive care is delivered. Legislation has already passed that will fund more primary care centers. I wonder and worry, however, how the quality of this outpatient care will be tracked. While the delivery of primary care is essential, we need systems to evaluate the delivery and effectiveness of these services.

There are very good independent databases for tracking inpatient care, complications, and patient outcomes. The overwhelming amount of care is delivered (and must be with prevention), however, on an outpatient basis. To my knowledge, there are no independent databases to evaluate outpatient care and this issue must be addressed if we are to improved healthcare quality.

Effective preventive care should diminish rates of hospitalization and decrease healthcare costs. Preventive health and wellness programs must address not only diseases such as diabetes and hypertension, but the leading causes of premature, preventable death in this country, obesity and tobacco use. We have just begun to explore the notion of how to partner and breakdown barriers between the healthcare profession and industry to gain the most from outcome effectiveness research.

Lastly, it is not clear which technological innovations in medicine that will allow transformative cost reductions. National Jewish Health, other Academic health centers and others can serve as laboratories for the innovations that are going to be requisite if we are to have success lowering healthcare costs. Ideas such as extending networks of care with protocols for the care of prevalent and common diseases, testing telemedicine models for primary or specialty care at lower costs, understanding the role of genetics in preventive and predictive health, and bringing together community-based and academic centers to form new business models of care that provide more efficient deliver of services should be rigorously evaluated.

These ideas and others should be considered as we move forward with the health reform debate. Colorado has a vested stake in these debates, and our unique expertise and views should be represented in the ideas and solutions under consideration. We should look at various models (such as Massachusetts) before swinging for the fences in one piece of legislation. There is little question however that the President's Health Forum was successful at setting the stage for the debate on a critical part of our future.

This letter appeared as a Guest Commentary in the March 10, 2009, issue of the Denver Post