Governor Lynch Delivers Keynote Address At National Health Initiative Forum
Discusses Efforts of Citizen Health Initiative to Use Technology To Improve Health Care Quality, Increase Access, Control Costs
Saying technology can be a powerful tool in improving health care quality, controlling costs and ultimately increasing access, Gov. John Lynch this morning delivered the keynote address at the eHealth Initiative's 3rd annual Connecting Communities for Better Health Learning Forum in Washington, D.C.
Gov. Lynch was asked to deliver the keynote address because of the work of the New Hampshire's Citizen Health Initiative, which he created to bring together health care consumers, providers, business leaders, workers, insurance experts and elected officials to focus on long-term solutions to New Hampshire's health care challenges.
" My goal is that 10 years from now, New Hampshire will still be one of the healthiest states in the nation, more of our citizens will have access to quality health care, and the growth in health care costs will be in line with economic growth, " Gov. Lynch said. " I created the Citizens Health Initiative to help turn that vision into reality. "
Recognizing that improving the health of citizens will ultimately help control costs and increase New Hampshire's ability to increase access, the Citizens Health Initiative is taking a health-first approach. A key part of the Initiative's efforts is to encourage citizens and providers to focus on prevention and quality.
" Far too much of what passes for reform these days is just pushing around costs. Congress would like to limit its increased Medicaid costs by pushing more onto the states. And some states are turning around and pushing those increased costs onto program recipients. Employers are trying to limit their responsibility while increasing that of their employees, " Gov. Lynch said.
" Meanwhile, despite the fact that as a nation we spend more on health care than most other nations, the underlying health of our citizens is not better than the people of other developed nations, " Gov. Lynch said. " Without real change, we risk our health care system collapsing. Until we stop focusing on shifting costs and start focusing on using the money in the system better, we will not fix our health care financing system. "
Technology can be an important tool in making meaningful and lasting reforms in the health care system, Gov. Lynch said.
" Information is to health care what raw materials are to manufacturing. If you don't have the right things at the right place at the right time in the right format the end product is flawed at best, or may not work at all, " he said.
" So I look at a system that may have as many as 98,000 deaths per year as a result of medical error and ask can technology help? I look at a system that has 30 billion transactions each year in the United States - and does 90 percent of those transactions by mail, phone or fax - and ask can technology help? I look at a system where the average Medicare beneficiary will see 6.4 different providers every year and ask would these providers having electronic medical records help? "
Recent studies show that up to 40 percent of outpatient prescriptions are unnecessary and that every year there are 2 million adverse drug reaction events.
" E-prescribing is one of the best examples of how technology can be used to improve quality and make the health care system more efficient, " Gov. Lynch said. " Would you want your banking records to be kept in your doctors' handwriting? I wouldn't. And if we won't accept handwritten records from our banks, do we really think it is good enough for the medications we depend on to keep our families and ourselves healthy? "
That's why the Citizens Health Initiative is working on an initiative to fast-track E-prescribing technology around New Hampshire. Initiative task members will complete by late May an in-depth survey of providers to determine the barriers to E-Prescribing and develop a plan to encourage its use.
The nation's current health care financing system relies on two extremes, Gov. Lynch said.
" Managed care contracts that appeared to award health care providers for not providing services, and the current fee-for-service variations that consider only on the number of procedures and tests provided. We need to find a middle ground that aligns financial considerations, quality and best practices, " Gov. Lynch said.
The Citizens Health Initiative is working with the major insurance providers in New Hampshire to create a consensus around what " performance measures " they will use to expand pay for performance.
" By moving toward a common ' pay for performance ' system, we will put the focus where it belongs: preventative health care, " Gov. Lynch said.
In addition, the Citizens Health Initiative, with the support of New Hampshire's major carriers, the Endowment for Health, and the University of New Hampshire, has created the New Hampshire Health Care Interconnectivity Project, aimed at creating a statewide health information exchange network.
" We are looking for a system that will include electronic medical records, a system that will allow us to reduce medical errors, reduce duplicative procedures, control costs, help encourage pay for performance, and ensure that patients are getting the highest standards of care, " Gov. Lynch said.
Developing electronic medical records must be done in a way that ensures patient confidentiality and privacy comes first, Gov. Lynch said, but, if that goal is accomplished, a common health information network for the state holds great promise for helping improve care and control costs.
In discussing the potential benefits, Gov. Lynch pointed to a medical practice in Penacook that used its electronic medical records to determine how often it was meeting the standards of care for diabetes. After reviewing the results, they revised the system to install new prompts that help ensure that chronic disease patients are getting the highest standard of care - care that will help keep them out of the hospital and reduce their long-term medical costs.
" There is no silver bullet. But I am convinced that we move forward using technology to help improve quality and control costs in the health care system, " Gov. Lynch said.
Gov. Lynch's prepared remarks follow.
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Gov. John Lynch
E-Health Initiative
3rd Annual Connecting Communities Forum
Tuesday, April 11, 2006
Thank you for that warm welcome, and I am sorry Congressman Gingrich couldn't be with us in person today. Thank you for giving me this opportunity to discuss how states, and how we as a nation, can move forward with improving the quality of health care and controlling the growth in costs.
I'd like to take a moment to tell you about my background. I have spent my professional life in both business and education. I served as dean of admissions for Harvard Business School and as chairman of the University of New Hampshire. I spent a number of years assisting in corporate mergers and turnarounds, and was president of a large furniture manufacturing company called Knoll Inc. And my wife, Susan, is a pediatrician who specializes in childhood obesity.
Finally, I have had the privilege of serving as Governor of the State of New Hampshire since January 2005.
In my experiences in business, education, and as Governor, one area of concern has remained constant: Health care.
As I travel across New Hampshire, health care issues come up more frequently than any others.
I hear from small business owners who are afraid that they will no longer be able to afford health insurance for their workers. I hear from parents worried about getting coverage for their children, and for themselves. I hear from health care professionals alarmed at the explosion of chronic diseases. And I hear from public officials and taxpayers worried about the increasingly larger percentage of government money directed toward health care.
I have acted to address some of the most immediate health care challenges facing our state. We continue to invest in our Children's Health Insurance Program and to enroll more children. We are focusing on offering seniors more home- and community-based care.
And Republican and Democratic lawmakers came together with me to pass a law to stabilize our small business health insurance market. We reached consensus to restore fairness and balance for both individuals and employers, stopping excessive penalizing based on geography, health status and age.
That was an important step for New Hampshire and it helped resolve an immediate problem. However, the issues the health care system faces in New Hampshire and across the nation are far greater. They are challenges that can't be solved with one piece of legislation, one reform or by looking at one aspect of the issue at a time.
As my wife Susan's work with childhood obesity reminds me every day, we must reform our health care system thoughtfully and by focusing on root causes, not simply the symptoms of its problems.
Far too often when discussing health care, we focus solely on illness, disease and trauma, and the system that we have built up to diagnose treat and pay for those treatments.
The work of the Institute of Medicine reminds us that if we are going to make real, lasting and meaningful reform in our health care system, we must return to the basics. The first step is to have a common definition of health, which the Institute defines " as a state of well being and the capability to function in changing circumstances. "
Step one is getting the right definition and a shared definition. The second step is to stop thinking about health in separate and isolated silos.
Too often our health care system is not communicating, and I am not just talking about the separation between who pays for care and who provides care.
As the Institute of Medicine said in its 1997 work " Improving Health in the Community " : " For too long, the personal health care and the public health systems have shouldered their respective roles and responsibilities separately from each other ... we need to invest in a process that mobilizes expertise and action ... if we are to substantially improve community and population health. "
We must discuss the triangle of cost, access and quality, and we must do so with an understanding of community health in its broadest sense or we simply will not be successful.
My goal is that 10 years from now, New Hampshire will still be one of the healthiest states in the nation, more of our citizens will have access to quality health care, and the growth in health care costs will be in line with economic growth.
To turn that vision into reality, a year ago I created the Citizens Health Initiative. I did not want just another task force; I wanted something that would outlast my time as Governor.
I wanted an organization that had the ability, the skills and the freedom to look beyond the next legislative session to how we reshape our health care system over the long term to improve quality, access and control costs.
The Citizens Health Initiative brings together 150 key leaders from every sector and all political parties - consumers, providers, insurers, business leaders, labor, academic experts, and government officials.
We are taking a health-first approach. We know that of the factors that affect our health 50 percent are based on behaviors, 20 percent on environment, 20 percent on heredity and 10 percent on access to medical care. And we know that if we focus first on improving the health of our citizens, we will also help control costs and increase our ability to insure more people.
Between 1900 and 2000, overall life expectancy increased by 30 years. What we must remember is that 25 of those years are the result of public health efforts, and only five of those years are because of enhanced medical procedures.
New medical technology, techniques and drugs have made a difference in countless lives. But it has been things like the reports from the Surgeon General on smoking, immunization, clean air and water, safe work places, cracking down on DWI's, and other such public health initiatives that have had the greatest effect on our health and the average life expectancy.
Before I discuss in depth the work of the Citizen's Health Initiative, let me paint a very brief picture of the underlying issues that make this effort critical.
The challenges we face are well known to you, and not very different in your own community, but they bear repeating. The average annual premium for employer-sponsored family health coverage has gone from $7,043 in 2001 to an estimated $14,565 in 2006. During that same period of time, the number of uninsured Americans has gone from 41.2 million to about 52 million.
At 12 percent, the percentage of uninsured in New Hampshire is lower than the national average. But when we include those people who have gone without health insurance for at least some period during the past 12 months, we find that the " at risk " uninsured population in any one year is about 20 percent.
And not all insurance is the same. High deductibles, premium cost sharing and co-payments can mean a high financial burden on even those people with health insurance.
In 2002, 44 percent of the people who applied for financial assistance with their hospital bills had health insurance. The reality is that a $2,500 deductible and 20 percent co-payment for an in-patient stay is well beyond the means of many families.
Personal health care expenditures in New Hampshire closely track the national average, which means that over the last decade they have gone from under $4,000 per capita to over $6,000. Our health expenditures are now about 16 percent of our gross state product and on pace to go even higher.
This cost places a huge burden on individuals, families and business.
As a Governor I am also mindful that when we combine Medicare, Medicaid and the premiums paid for public employees at the municipal, state and federal level, almost 60 percent of health care expenditures are public dollars.
Far too much of what passes for reform these days is just pushing around the costs. Congress would like to limit its increased Medicaid costs by pushing more onto the states. And some states are turning around and pushing those increased costs onto local governments and program recipients. Employers are trying to limit their responsibility while increasing that of their employees.
We are approaching a dangerous spiral, the cost of the uninsured drives up everyone's health care costs, but as those health insurance costs go up, more people are going without health insurance.
Meanwhile, despite the fact that as a nation we spend more on health care than most other nations, the underlying health of our citizens is not better than the people of other developed nations.
Without real change, we risk our health care system collapsing. Until we stop focusing on shifting costs and start focusing on using the money in the system better, we will not fix our health care financing system.
We need to search for solutions that do not put our basic social values in conflict with our programs and exigencies of the moment. This will take time, the commitment of existing stakeholders, heightened public concern and pressure, a willingness to face our choices honestly and explicitly, and above all, it will take leadership.
It is my hope that the Citizens Health Initiative will provide the long-term support and leadership necessary for New Hampshire.
The Initiative has three Policy Teams with focused and concrete first-year agendas. Common to each of these teams is a deliverable around the use of health information technology.
The Health Promotion and Disease Prevention Team, headed by the Dean of the School of Health and Human Services from the University of New Hampshire, is developing a document focusing on what makes us sick, what kills us, and what keeps us well in New Hampshire.
We intend to use this work to prepare briefing papers for policy makers; presentations to the public and business; and public information campaigns, to awaken our population to the things that we do every day that help, or hurt our own health.
To a large extent, the power to improve the health of our citizens lies in the hands of our citizens and the environment we create. We must spur our communities and our citizens to take action.
The second team is the Quality of Care and Best Practice Team headed by the recently retired Medical Director of Tufts Health Plans, and it is focused on two efforts. First they are assembling a plan that will allow our state to aggressively address access to care by focusing on assuring a robust primary care workforce.
Like every other state, we are facing a critical shortage of primary care health care workers of all types. The Team intends to bring forward a range of recommendations that will make our state proactive and take advantage of the organizations and initiatives that can help address this shortage.
Among the ideas the team is exploring are the early introduction in our schools of the importance of health careers in the future, examining the underlying economics of a system that reward specialists far more that primary care professionals, and the use of scholarships and loan forgiveness plans.
The Team is also focusing on a major quality initiative to fast track E-Prescription technology around the entire state. Recent studies indicate that up to 40 percent of outpatient prescriptions are unnecessary and that every year there are 2 million adverse drug reaction events. E-Prescribing is one of the best examples of how technology can be used to reduce unnecessary medical errors and make the health care system more efficient.
It's easy to get excited about technology, and to get lost in the details. But that won't help us increase the use of technology in the health care system. We have to present E-Prescribing to the public and the medical community in a way that makes everyone say, " okay, that makes sense. "
And the most important reason for this technology is patient safety and patient health. When I am trying to make the case for E-Prescribing, I just ask, " Would you want your banking records to be kept in your doctor's handwriting? "
I wouldn't. And if we won't accept handwritten records from our banks, do we really think it good enough for the medications we depend on to keep our families and ourselves healthy?
The final team, the Finance and Information Team, is headed by a retired banker and former state legislator (a Republican I might add) and has two key tasks. It is attempting to encourage people to rethink the financial logic behind our health care system.
We have seen two extremes in our financing system. First badly designed managed care contracts that appeared to award providers for not providing service, and the current fee for service variations that are contingent only on the number of procedures and tests provided. We need to find a middle ground that aligns financial considerations, quality and best practices.
That is why this team is working to create a consensus among our major commercial payers on what " performance measures " we will use in New Hampshire to expand pay for performance. By moving toward a common " pay for performance " system, we will put the focus where it belongs: preventative healthcare.
This team's second task is to take the substantial and growing information on cost, quality and medical treatment options, and put it in a format that is useful and accessible to this initiatives four target groups: the public at large, policymakers, purchasers - both public and private, and providers and payers.
We are making progress in each of these areas and I am confident that our first year will give a solid foundation for the hard tasks that will follow.
I mentioned that each of these groups had a third task, and I am pleased to say they have done well on that common endeavor.
I asked that each of the teams think carefully about improving our ability to capture health information in ways that would enhance our efforts to improve our health care system.
I specifically charged the Finance and Information Team with exploring the creation of a Health Information Exchange Network and determining how such a network could help us improve all aspects of the health care system - quality, business and operations.
Working with eHI, and with the financial support of New Hampshire's major carriers, the New Hampshire Endowment for Health, and the University of New Hampshire, earlier this year we launched the New Hampshire Health Care Interconnectivity Project, a multi-phased project aimed at helping us meet this important goal of the Citizens Health Initiative.
Let me take a brief step back and define what we are looking for in a Health Information Exchange Network. We are looking for a system that will include electronic medical records, a system that will allow us to reduce medical errors, reduce duplicative procedures, control costs, help with encouraging pay for performance for health care providers, and ensure that patients are getting the highest standards of care.
But the phrase, " electronic medical records " can be a little frightening, even to those of deeply involved in these issues. I think all of us get a little queasy thinking about our medical records being just " out there " in the electronic universe. What if our spouses found out what our cholesterol levels really are?
So if we are going to make electronic medical records a reality, we need to allay the justifiable concerns people by ensuring the privacy and security of these records. Equally important, we have to demonstrate how electronic medical records can help patients live longer and healthier.
There is a medical practice in Penacook, New Hampshire that I think perfectly demonstrates just how helpful and important electronic medical records can be in improving care and controlling costs.
In a presentation to the Initiative, this doctor walked through the work that he and his colleagues had done on chronic disease management. Not surprisingly, when they got together to talk about how they were treating their diabetes patients, every practitioner believed they were providing consistent and excellent care.
Then they looked at the facts they gathered from their Electronic Medical Records, particularly at Hemoglobin A1C's and other critical indicators of care. They were stunned at the results, and thought that the data must be wrong. It wasn't. They weren't consistently meeting the care standards recommended for diabetes patients.
Armed with that new awareness, they built into their electronic medial records system prompts to make sure they were meeting care standards every time they met with a patient with diabetes. As a result the consistency of care, with all the physicians in the practice, has improved steadily and permanently.
To move forward with New Hampshire's Interconnectivity Project, first, we need to know what's already out there.
We are surveying health care providers of every type, and conducting many one-on-one interviews as well, to find out what is the technological capacity of New Hampshire's health care providers, how are they using technology, what obstacles do we face, and what are the opportunities to use technology to improve care.
With the results of the survey and the interviews, we will assemble a road map for how New Hampshire can take full advantage of a thoughtfully conceived, secure and robust system of interconnected health care information. This is an area where New Hampshire's small size and history of public-private partnerships gives us an advantage.
The major players are already at the table - from health care providers to insurance providers to business owners and consumers to government officials - and they share a commitment to moving forward, and are already working to move forward independently and together.
New Hampshire's hospitals, for example, with our encouragement but without a government mandate, have established a website that will tell consumers how often hospitals are meeting the highest standards of care for certain common conditions - compared to the state and the national average.
Do patients get aspirin when they arrive in the hospital to be treated for a heart attack? Are antibiotics being given at the right times after surgery to prevent infections?
Not only does this information allow all of us to be better consumers of health care, but it provides a very public incentive for hospitals to do better - just as how looking at how they treated their diabetes patients encouraged that practice in Penacook to take a second look at its basic treatment.
And when hospitals and doctors are following best practices, we are avoiding future unnecessary health care costs.
We are intent on making sure that this effort, our Citizen's Health Initiative and the application that we recently made to the NGA/RTI project, will provide us with resources that can carry this critical work forward.
Let me go back to where I started to make a point on how important I think all these initiatives are, and underscore how critical the focus of this conference on health information exchange is.
As I said, my wife is a physician and so I am fortunate to have a unique window into this area based on her work and understanding. But I also come at this from the perspective of a businessman who ran an international manufacturing corporation.
In my view, information is to health care what raw materials are to manufacturing. If you don't have the right things at the right place at the right time in the right format the end product is flawed at best, or may not work at all.
So I look at a system that, according to the Institute of Medicine, may have as many as 98,000 deaths per year as a result of medical error and ask can information technology help as it has in so many other sectors?
I look at a system that has 30 Billion transactions each year in the United States and does 90 percent of those transactions by mail, phone or fax and ask can information technology help?
I look at a system where the average Medicare beneficiary will see 6.4 different providers every year and ask would the ability of those providers to have interoperable electronic medical records help?
I look at research that says that more than 40 percent of outpatient prescriptions are unnecessary, that there are 2 million adverse drug events each year, yet at the same time patients are only receiving half of necessary care and I ask, could a secure electronic monitoring and measuring system help?
And I look at a system where the most robust confidential information that we can assemble is based on claims, which is primarily a financial transaction and ask if we truly wish to reimburse our providers for the quality of care they provide and not the q uantity, and if we really want to understand how well we are doing for the millions of people with chronic disease, is it not imperative that we collect the data that will allow us to do that?
If, as I said a moment ago, information is our raw material at all levels of health care then I am convinced that we must move forward in this area, coupling our commitment to progress with an absolute commitment to patient confidentiality.
We must value the health of our community and we must focus on maintaining and preserving it. We must understand that our power to use information as a critical ally in that effort is not a choice but an absolute necessity.
The work of eHI and all of you is critical in this regard.
So let me leave you with a few thoughts that I think we must keep in mind as we undertake this effort for fundamental change in our system of health and health care.
First, there is no silver bullet. You know that and I know that, but it is still no excuse to run around shooting blanks about issues that make noise but have no real effect on the tangible issues before us.
Second, we can't talk our way out of a situation that we have behaved our way into. We spend twice as much on health care as the median of the other industrialized nations and leave 20 percent of our people outside the system. It's not a question in my judgment of enough resources as it is behaving in a way that gets the most value from those resources.
Third, I am committed to making sure the effort we have begun in New Hampshire takes on a life of its own that outlasts the term of any one office holder. This truly must be a citizens' initiative.
Finally, we value the partnership that we have with eHI and with many other state people and organizations that have helped launch our work. But we are in this for the long haul. And I hope that all of you in each of your communities can generate that same sustained intensity.
We owe the promise of sustained healthy communities to ourselves our children and to every citizen of this country.
Thank you.
http://www.nh.gov/governor/news/documents/041106keynote.htm