Three experts at the forefront of health care shared their perspectives and explained some of the complex details of health care reform at a recent forum attended by more than 125 members of the community and leaders of the medical field.
The Overlook Health Care Forum, a new initiative designed to provide dialogue and discourse among opinion leaders in the community, featured a panel which included Margaret Koller, MS, Executive Director of Rutgers Center for State Health Policy; Wardell Sanders, Esq., President of the New Jersey Association of Health Plans; and Joseph A. Trunfio, Ph.D., President and Chief Executive Officer, Atlantic Health System, the nonprofit parent organization of Overlook Medical Center.
Funded by the James C. Kellogg family of Short Hills, the May 9th event was hosted by Overlook Medical Center Foundation at the Hilton Short Hills and featured a panel discussion followed by questions from the audience. The moderator, William D. Neigher, Ph.D., was chief strategy officer and vice president of system development for Atlantic Health System. Overlook Medical Center president Alan Lieber welcomed the audience and panelists.
The panelists began the discussion by explaining the goals of the federal health care reform law, the Patient Protection and Affordable Care Act of 2010. “I think that one of the strategies of the affordable care act is to finally get to the cost issue and make the delivery of care more efficient, get better outcomes and improve the quality of care,” Koller explained.
Sanders likened the 2010 reform law to “a big bucket that, every idea over the last 20 to 30 years, someone had thrown in that bucket.” The focus, he said, has been to set up health care exchanges, which are government-regulated marketplaces for health insurance plans.
Neigher asked the panelists whether the changes enacted by the reform law would allow families to get better coverage, to which Sanders responded that access to insurance would be tied to affordability.
Trunfio underscored the need for health care reform as thousands more Americans reach traditional retirement age every day, requiring more health care services while less money is being paid into health care programs such as Medicare than is being taken out of them.
“Unless there is a new model of health care, this country cannot afford to provide health care the way it is done today,” Trunfio said, noting that the current push to reform health care is actually “a race between innovation and reducing cost, (versus) bankruptcy.”
Health care reform, as enacted, will change our current system, which is based on rewarding volume of services, to a new system in which financial reward is tied to higher quality outcomes, as well as preventative care, Trunfio said.
Peter Bolo, chair of the department of psychiatry and chair of behavioral health for Overlook Medical Center, asked the first question from the audience, seeking to find out how to encourage people to learn more about palliative care, without making them fearful of what some critics of the federal health care reform law have deemed “death panels.”
Neigher responded, noting that less than 19 percent of the community comes to the hospital prepared with a living will or advanced directive, stating what level of care they wish to receive if they are unable to make medical decisions. Without such directives, he said, patients could potentially receive thousands of dollars’ worth of unnecessary or unintended care. Sanders agreed, saying that the solution would be partly educational and partly regulatory.
Summit resident Clelia Biamonti, a trustee of the Overlook Foundation board, asked whether payors, such as insurance companies, would begin requiring patients to seek less expensive forms of care, and how that scenario could affect hospitals.
Sanders replied that there has been a movement in the health care industry towards networks that provide different tiers of health care that allow cost-sharing to address this.
“The sweet spot is where the quality is high and the cost is low,” Sanders said.
Bruce R. Petrie, an insurance broker and attorney based in Morristown, asked the panel for their opinion on New Jersey’s decision to allow the federal government to operate the new health care exchanges that are part of the reform law. Under the law, as written, penalties can be applied to an employer with 50 or more if the exchange is run by the state.
“Is an employer going to challenge the law if there is no state-based exchange?” Petrie asked.
Sanders said that a challenge, if made, would likely be made through the court system.
Koller noted that there will still be products available outside of the exchanges, and that insurance brokers would still have an important role to help small employers.
The event was attended by local municipal officials, including Summit City Council President Richard Madden and City Council Members Al Dill and Tom Getzendanner, as well as Mountainside Borough Council Member Glenn Mortimer.
Madden, noting studies showing that the amount of money that is spent in the United States on health care exceeds the effectiveness of health care, said he would like to see that gap closed.
“I’d like to see some people in the industry solve this before costs keep going up,” Madden said.
“Overlook Medical Center is one of Summit’s greatest assets,” Madden said. “We’re happy to have the medical center in Summit and have Overlook as a part of us.”