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Show HEALTH POLICY SEMINARS Abstracted from Summaries Prepared by the Utah Health Policy Commission The Utah Health Policy Commission and the University of Utah's Scott M. Matheson Center for Health Care Studies sponsored three seminars during 1996 to discuss issues now before the Health Policy Commission. Health Care Quality Improvement, held at the University of Utah in May. The discussion showed important disagreements about what presumptions and priorities ought to guide quality improvement efforts. Larry Staker, MD, VP of Medical Research, Intermountain Health Care, described how a provider could examine his own practice patterns and uncover variations in practice across patients with similar conditions. Keith Petersen, MD, Medical Director, Blue Cross\Blue Shield of Utah, explained a new profiling system of physician variation in patterns and costs of care. Physicians are encouraged to make changes to improve care and reduce costs. Annie Holt, RN, VP, Clinical Integration, Columbia Utah Division, showed how clinical data can be used to assess whether patient care is timely and appropriate, and where prevention in the treatment of chronic disease could improve the quality of care. Denise Love, MBA, Director, Office of Health Data Analysis; Ken Buchi, MD, Associate Chief of Staff, Ambulatory Care, VA Medical Center; and Dennis Batey, MD, VP of Medical Affairs, for FHP of Utah, agreed that building consensus around what to measure in assessing quality is important. But Representative Mary Carlson and John Holmgren shared the concerns of the legislature that the health care industry must assume stronger and more evident responsibility in helping to improve quality, access to care, and reductions in cost. Mark Bennett, VP, Program Operations, Healthlnsight, explained that their approach to quality improvement is a collaborative/ educational effort to improve the general practice patterns of care. This approach has shown faster improvements in quality of care and reductions in cost. Mike Deily, Division Director, Office of Health Care Finance, pointed out that the Medicaid program can provide strong incentives for plans to improve the quality of their care. Rural Health Care, held at Snow College. "Still facing us today is the challenge of defining what is meant by rural," said Jean Jones. "Each rural setting is unique to that area so there will never be one solution for all of the problems." Partnerships between urban and rural areas will assure better quality of care and access. But because rural medicine is practiced in a similar manner to urban area medicine, the equipment, technology, and supplies are similar to their urban counterparts. However, economies of scale are not realized because rural areas service half the population, and therefore health care costs are higher. In addition, with many of the patients uninsured or on Medicaid, the financial make up of a rural health care system is so delicate that losing five or six insured patients to an urban area, because of an HMO referral panel, could impact the ability to provide care in that area. "Perhaps a rural based HMO or network that pays the local providers through capitation could keep the health care dollars in the local communities," offered Kim Bateman, MD. "Put the rural providers in the driver's seat by allowing them to arrange for preferred specialists and referral hospitals, as well as utilization and quality rules. If discounts could be levied on urban systems, rather than the reverse, then profits could stay local." "Because rural legislators have a strong political network and can gather support in a short time, there are opportunities for developing rural programs," added Lt. Governor Olene Walker. "However, there is a seasonal nature to rural health care where some communities will literally double in a short period of time and then there is a long dry season, mainly the winter, where you are back to a low population. These influences make maintaining a viable hospital or health care system even more difficult." "Long-term master plans are needed to assure the viability of a rural hospital or clinic," stated Chuck Davis. "It's essential to include all stakeholders in maintaining the critical mass for a self-sustaining system by balancing four important elements: the healthcare needs of the community, an effective local governing board, an involved medical staff, and a competent administration." "People with special health care problems or long term care are not getting their needs met by the rural health care system," stated Robert Rescendes, MBA, Executive Director - Central Utah Public Health Department. "Telemedicine is just now being implemented in the rural areas," advised Mike Magill, MD, Department of Family and Preventative Medicine, "and has the capability of rapid access to consultants for remote Utah's Health: An Annual Review 1996 129 |
