Conner Lecturer – Healthcare changes must focus on value

A transformation in health care requires vision, values and leadership ? and physicians are best poised to be transformative leaders, according to Ian Morrison, Ph.D., president emeritus of the Institute for the Future.

In his Lewis A. Conner Memorial Lecture Sunday afternoon, Dr. Morrison spoke with humor, insight and forethought in describing the current state of health care and what is needed to create an effective health care delivery system in the United States.

In reviewing the changes in health care over the past decade, Dr. Morrison, a specialist in long-term planning with an emphasis on health care, noted that none of the expectations of the 1990s have been realized.

The primary reason for this lack of enhancement, he said, is that health care changes have not addressed fundamental problems.

?Unbelievable amounts of high technology have been put on a frame that is tired, old and ineffective,? said Dr. Morrison, who added that enormous variations in practice and spending exist across the country.

Dr. Morrison noted that the cost and quality of health care are inversely related. ?We?re getting it right about 50 percent of the time,? he said, noting a study demonstrating that adults receive about half of recommended care.

Adherence to quality indicators is slightly higher for patients with coronary artery disease, hypertension and congestive heart failure, but these percentages range from 63 percent to 68 percent.

Shifting the burden of health care costs to consumers has not been effective, and the 80-20 rule exists in health care.

According to Dr. Morrison, one problem is that 5 percent of consumers account for approximately 55 percent of costs.

More importantly, he added, ?If you make [consumers] pay, they become noncompliant.?

He described surveys that have shown the rate of noncompliance for individuals with high deductible health care plans was twice the rate for individuals with private insurance. Such noncompliance held even for individuals with high-deductible health plans with health savings accounts.

Dr. Morrison suggested that health care consumers need positive benefits, such as point-of-care incentives and earned benefits, to maintain compliance. Caption: Romualdo Belardinelli, M.D.


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