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Health care costs continue to increase at an accelerated rate, leaving employers, consumers, health care providers, insurers and public officials to struggle with the twin issues of rising costs and the uninsured.

 

Much public and media discussion recently has been devoted to the subject of health care reform, which promises to be one of the top two domestic issues during this high-profile presidential election year.

 

One in three Americans carries a Blue Cross and Blue Shield health plan ID card, meaning that the national Blues system has both a vested interest and a strong sense of responsibility to provide leadership on these issues which are critical to the nation’s health and economy.

 

The Blue Cross and Blue Shield Association, a trade association representing the country’s 39 independent Blue Cross and Blue Shield Plans, recently unveiled a broad strategy called “The Pathway to Covering America.” This road map provides five general recommendations aimed at increasing the quality and value of health care while improving access.

 

1. Encourage research on what works. Too often treatments for a specific condition vary significantly from clinician to clinician, with no apparent reason for the disparity. All patients should receive quality, consistent care based on the most current scientific knowledge and research. “Evidence-based medicine” promotes the sharing of accepted best medical practices to improve the quality and efficiency of health care. Improvements in medical research and health care IT are required to move toward an evidence-based system.

 

2. Change incentives to promote better care. Earlier this decade, the Institute of Medicine’s report Crossing the Quality Chasm: A New Health System for the 21st Century proposed a fundamental shift in the way health care providers are reimbursed. The current utilization-based model pays providers almost solely based on the type and number of medical services provided, which creates incentives for redundant, ineffective and even harmful care. Although vigorous debate continues regarding alternative reimbursement models, an outcomes-based approach rewards providers based upon the success of treatments and the health of patients, not numbers of procedures. Most agree, however, that the current utilization-based paradigm should change.

 

3. Empower health care consumers and providers. Both consumers and health care providers need access to better information and tools to make informed health care decisions. Investments in health care IT are needed to promote the efficient sharing of health care cost and quality information.

 

4. Promote health and wellness. We must transition from illness-based to wellness-based health care, with a greater emphasis on prevention, education, lifestyle choices and managing chronic illnesses.

 

5. Foster public-private solutions. Oklahoma pioneered a shining model for public-private partnerships with Insure Oklahoma, the state’s health care premium assistance program. More cooperative efforts are needed to cover more uninsured Americans – those who are “squeezed out” of the system due to rising costs; those who “miss out” on public assistance programs for which they are eligible and those who “opt out” because they don’t think they need health coverage.

 

Obviously there is no single or simple solution to address the cost, quality and access challenges we face in health care. Substantive change will require thoughtful and coordinated efforts from everyone at the table. But together we can achieve the goal of a modern health care delivery system equipped to keep citizens healthy throughout the 21st century. Let’s go to work.