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MMA Board Approves Reform Road Map
Minnesota’s physicians have endorsed a bold vision for the future of health care in Minnesota. On Jan. 22, the MMA Board of Trustees approved a set of recommendations from the MMA Health Care Reform Task Force—a 21-member task force that met nearly a dozen times during the past year. This is the MMA’s first attempt to create a comprehensive outline for health care reform since 1992. The recommendations come at a time when business, government, and other leaders have made health care reform a top priority.
The task force envisions a new model for health care delivery, which includes a strong public health system; universal health insurance coverage; and a health care market that promotes competition, quality, and transparent pricing.
“We’ve got some good ideas,” says Judith Shank, M.D., former MMA president and chair of the task force. “And our ideas will generate more ideas.”
Establishing a Direction
The task force concluded in its final report to the board, titled Physicians’ Plan for a Healthy Minnesota, that Minnesota already spends enough to provide quality health care for all its citizens. What is needed is reform in the following four areas to eliminate waste, improve care, and check rising costs:
• A reformed health insurance market. Achieving universal coverage is a key step toward creating a better and more affordable health care system in Minnesota. To make this happen, the task force recommends a mandate requiring all Minnesotans to have health insurance.
The task force’s plan calls for a communitywide, physician-led discussion that would lead to the establishment of an essential set of health care services. The state would then require Minnesotans to have insurance for those services. The task force envisions subsidies for those unable to afford the basic level of insurance.
All insurers would sell this basic benefit for the same price. Insurers would determine the price based on a communitywide estimate of the cost rather than on an individual’s age or health status. Insurance companies would compete by offering supplemental benefits beyond the basic set of services that anyone could choose to purchase.
• A reformed health care market. The task force also advocates for patients to better understand how their behaviors affect their health and become more engaged in their health care choices by considering the cost and the effectiveness of treatments. To do so, patients need more information.
Now, patients often are insulated from the true cost of health care. Insurers also confine them to particular networks of doctors. Under the new system, patients, not large payers, would control health care spending. Insurers would continue to negotiate payment rates with providers but would not limit the prices providers can charge. The system would then encourage health care providers to compete on price, which would keep prices in line with value. Engaging patients in the purchasing process would help eliminate unnecessary care and hold down costs, according to the recommendations.
The task force also calls for state and federal governments to stop arbitrarily setting prices for care and to buy health care in the same manner as private purchasers. The current policy simply shifts costs.
• A market that supports high-quality care. The task force found that attempts to control costs should focus on reducing chronic diseases, which consume most of the health care dollars spent in Minnesota. It calls for policies and incentives that encourage the use of evidence-based guidelines, disease management, and preventive care. Investments should be made in electronic medical information systems. And the system should help each Minnesotan find a “medical home” with a personal physician.
The task force also supports initiatives that provide patients more information about the cost and quality of health care in the state, so they can make smart health care decisions.
• A stronger public health system. The state and the nation need to invest more heavily in the prevention of disease. The report calls for Minnesota to enact public health policies such as a higher tobacco tax and clean-air laws in order to prevent illness such as cancer and heart disease. Obesity prevention also needs to be a top priority.
Next Steps
The task force members acknowledged that their recommendations leave many unanswered questions. To find answers, the MMA will convene discussions with health care providers, health plans, government officials, business leaders, and other stakeholders to build support for its plan and to fill in the details. The MMA also will move forward immediately by supporting a stronger public health system, prevention initiatives, and market reforms promoting quality and value.
Obesity and Hispanic Health
To his patients, MMA president J. Michael Gonzalez-Campoy, M.D., Ph.D., F.A.C.E., medical director and CEO of the Minnesota Center for Obesity, Metabolism, and Endocrinology, is known simply as “Dr. Mike.” Here, Gonzalez-Campoy, who serves a large Hispanic population in his Eagan, Minnesota, practice, shares his observations about health, access to care, and obesity in the Hispanic community.
Q.What concerns you most about the health status of the Hispanic patients you treat?
A.The biggest challenge for the Hispanic population that I see is getting coverage for the things I think they need. Many of the Hispanic patients we care for are on state programs. Because Medicare did not recognize obesity as a disease until August, the state programs followed suit. The consequence of the lack of recognition of obesity as a disease is that doctor visits for obesity were not paid for by the federal government or state government, medications for obesity were not paid for by the federal government or state government, visits with dieticians were not covered by the federal government or state government. The patients I take care of who are biologically at a higher risk for diabetes—being Hispanic is one of the risk factors for diabetes—have to wait to become sick before we can start working with them. In my mind, that’s asinine.
Q. You’ve said that teen Hispanics are the fastest-growing segment of the overweight population. Can you elaborate on that?
A. The National Health and Nutrition Examination Surveys done between 1999 and 2002 found the percentage of Mexican-American boys 12 to 19 years of age who are overweight is 27 percent; the percentage of Mexican-American girls is 16 percent. That compares to 13 percent of non-Hispanic white adolescent boys and 10 percent of non-Hispanic white adolescent girls.
Q. Why are so many Hispanic teens overweight?
A. Fifty percent of obesity is genetic, 50 percent is environmental. What happens to Hispanics when they come to the United States is what happened to every other immigrant group. They come to a society where they have plenty of incentives for energy consumption—cheap, high-calorie diets—and they have every disincentive for physical activity. They drive places, use remote controls, etc. The genetic predisposition is there, and the environment allows those genes to express themselves.
Q. Is there a cultural component to this as well?
A. Many Hispanic immigrants come from places where they were barely able to eat. The culture that they grew up with was that you thank God for the food you receive, and you clean your plate. Now they’re in a society where portion sizes are bigger, and they’re still cleaning their plates.
Q. What other barriers do the Hispanic patients you see face?
A. Language is a barrier for a lot of patients. Lack of transportation is another. The Hispanic community includes a large number of individuals who are poorly educated and sometimes even illiterate. They rely on home and folk remedies. The culture that they come from focuses on letting the body heal itself. Illegal aliens pose a particular challenge because they allow themselves to become deathly ill before they come in because they’re scared that they’re going to be sent back to their home countries.
Physicians to Measure Up
The need for physicians to start measuring waistlines during routine visits was one topic of discussion at the first meeting of the MMA Task Force on Obesity in January. Charles Billington, M.D., associate director of the Minnesota Obesity Center, chairs the task force that will guide the MMA’s efforts to prevent and manage obesity. The disease is one of the MMA’s top two public health priorities. Smoking prevention is the other.
Additional topics discussed at the first meeting included the obesity epidemic, especially among children, and the frustration physicians often feel trying to treat the disease.
The task force members also discussed the possibility of the MMA, the Minnesota Department of Health, and the Minnesota Council of Health Plans joining together to designate obesity as a treatable disease. Members also considered whether body mass index should be the fifth vital sign.
Other discussion topics included encouraging the creation of payment models for obesity care and finding ways to inspire and educate physicians about treating the disease.