Coming together

Mary Grealy of the Healthcare Leadership Council explains how collaboration in the industry and the council’s lobbying efforts are bringing about change.

“It is much more powerful when you have a hospital making the case on behalf of a pharmaceutical company”
-Mary Grealy

A diverse organization with the challenging task of representing the many sectors within healthcare, the Healthcare Leadership Council is comprised of both publicly traded healthcare companies as well as not-for-profit entities representing pharmaceuticals and health insurance plans. Unifying these various organizations is the desire to achieve a high quality, high value, cost efficient healthcare system that's accessible to everyone and as Grealy explains, the council has spent a lot of time reaching a consensus among its members to form this, emphasizing the issue of the uninsured as well as patient safety, quality and payment system reform.

"I have not seen any dispute between the for-profit versus not-for-profit and it's even more remarkable that we are able to get hospitals, health plans and manufacturers around the table and they truly check their individual agendas (and also their weapons) at the door," she laughs.

Grealy explains that this was no less of a surprise to her when she first began the role over 10 years ago. Previously working at two trade hospitals she had much experience seeing the hospital association fighting with the health insurance association and the AMA. However the council avoids this problem by electing individual CEOs as members, with each working together to find the common ground. "They understand that if the different sectors don't work together, then you have a divide and conquer strategy and it's not good for the overall system," she says.

Innovative reform

A primary function of the council is to lobby, be it members of Congress or the administration and its various agencies, but the council also serves as a source of information for congressional staff conducting a great deal of Hill briefings on particular issues. The fundamental goal of the council is change: canvassing healthcare reform.

Having a combination of a pharmaceutical company, a hospital CEO and a health plan all campaign for the same issues is a great tactic for change - often putting a member of Congress a little off center, explains Grealy. "It is much more powerful when you have a hospital making the case on behalf of a pharmaceutical company and they are all talking about the dangers of price controls and that it inhibits innovation.

"We need to make changes in our healthcare system, but we want to make sure that we don't throw out the baby with the bathwater and that we protect those things that are good about our healthcare system," she says. "Innovation is one of the key principles that we feel very strongly about - we want to ensure that whatever we do as part of healthcare reform that we protect and foster innovation.

"That can be a big part of the solution in what we're trying to achieve with a reformed healthcare system, and so as well as new products and services that will improve the quality and efficiency of healthcare. We're also looking at benefits design and how can we move our system from one that has been about treating sickness and move it more towards how we can prevent illness in the first place and the innovative ways that we could be doing that."

Patient care

Grealy points to recent data that displays the progress the healthcare system is making: longevity is now at an all time high as diseases continues to be overcome. She notes the advancement in breast cancer treatment and the return on the investment of dollars that have been put into the disease by not only an increase in the lengthening of life, but also in productivity. "When we're able to shorten the length of stay in a hospital, that means that that person is back to work and contributing to the economy.

"As we're looking at the cost of medicines, or medical devices, we also need to take into account what those things are doing. What we're seeing is that they're not only producing longer lives, but also healthier lives. It's been remarkable looking at our aging population, but it's a much more vibrant population than we've had before."

However, these are not new issues for the council. Grealy explains that on appointment to her position the uninsured was to be its number one issue. The readiness of the CEOs of various institutions to operate on metrics provided them with the data to understand the problem and formulate a solution. Knowing whom the uninsured comprised of was pivotal - the Council took five months to analyze information and resulted in the now commonly known statistic of eight out of 10 uninsured living in a household where at least one person is employed. The population of the uninsured belongs to America's workforce, with nearly half of those offered health insurance by their employer refusing.

Cost is often a factor with many taking coverage for themselves but not for their dependants, family coverage being more expensive. What emerged from the results was that the uninsured were a gap in the population, overlooked because of their mediocrity - Medicaid is provided for the very low income, state children's health insurance programs for children, but nothing for the employed population who cannot afford to pay.

The Healthcare Leadership Council has made this group a priority, as well as investigating further into those who appear to be covered. "Nearly half of those who are eligible for Medicaid or the children's health insurance program are not enrolled so we launched an initiative called Health Access America to help do outreach in different communities," says Grealy.

"We did 10 pilot sites and we focused not just on those public programs but also brought in private insurance brokers and had them help small business owners and individuals, looking at the products that are available and how much they cost. We also had someone from the state that could help sign someone up for the children's health insurance program or for the Medicaid program and amazingly nearly half of those that attended these programs left with some type of coverage. So that's the grassroots outreach work that we've done.

"Then of course we're also working with members of Congress, with our solutions, which are pretty simple - making sure that those public programs are working well. We need to provide a helping hand to those that are unable to afford the insurance that's being offered to them by their employer, and providing some kind of premium subsidy to help them. We are also working with small business and helping them understand what's available, how much it costs, because they often don't have a human resources person and so helping provide them information on how they can provide health insurance to their employees."

As well as its work for the uninsured, the Healthcare Leadership Council has been a very strong supporter of Medicare prescription drug benefits. For a long period of time, private health plans provided prescription drug coverage to the population under-65, ignoring that those with the greatest need for those drugs are the over-65, the Medicare population. The council worked not only towards the commitment of passing the legislation but also ensuring that people understand how to get the prescription drug plan that worked for them, what would be most cost-effective and cover their needs.

To bring this about the council formed a coalition of over 400 national and local organizations, conducting thousands of events to educate people - all of which was done two years prior to them implementing it. "For the first 18 months we were just educating people about what's coming and what will be available and then after that, when the plans were finally available, actually going out and helping people sign up and enroll in the program that would work best for them.

"On a personal level it was one of the very few times I've had the experience of working on legislation and then actually getting to meet the people that would be helped by it, so it was a really gratifying project to work on. It's been a phenomenal success; there's a satisfaction rate of over 80 percent and I don't think you find that in too many programs, so that was a big plus, and the program actually wound up costing less than had been projected so that was another positive as well," says Grealy.

Alongside the issue of health insurance cover is the council's desire to change the incentives within the current system. America is practicing evidence-based medicine; patients are becoming partners in their healthcare and becoming involved in prevention and wellness. Grealy notes that 70 percent of healthcare expenditure is for chronic disease and if the American public can be persuaded to liver healthier lifestyles this could be reduced significantly. As well as this, Grealy advocated moving away from a system that pays only for volume and moving towards one that pays based on outcomes and the value of the work that is done.

Heading up patient safety and addressing another topical issue, is an executive level taskforce with many of its members being leaders in the various quality improvement initiatives. "One example would be Premier, an alliance of not-for-profit hospitals, which has participated in the center for Medicare and Medicaid services hospital quality improvement demonstration projects," says Grealy. "What they were able to demonstrate is improving quality can reduce costs. It improves outcomes but it also reduces costs.

"There's also a physician group practice demonstration project going on. Marshfield Clinic is participating in that and again, being able to demonstrate we can save money by not only rewarding the right behavior, but more importantly providing information, sharing best practices, sharing your results compared to other hospitals or physician group practices' results."

Electronic health records

She notes that the council's members are supportive of the adoption of electronic health records and the use of IT: a tool for practicing evidence-based medicine. "How do we develop the appropriate quality standards and how do we start rewarding those that adopt those practices to reduce the disparity of treatment, both geographically and among populations, by making sure people know quickly what are the best practices rather than it taking something like 17 years for known good practices to be disseminated widely?"

However, she's not convinced that the exchange of information between healthcare institutions is realistically viable, not soon anyway. "It's not just the financial aspect, it's also a big cultural change. "From what I've seen among our members it takes the leadership of the organization being engaged in this, making it clear that they believe it's important and that they want everyone on board with it, that it is the right thing to do and it's not easy but our members have done it. Many of our members did it without expecting to see a return on their investment. They thought, 'We're going to make this huge investment; it's going to provide better care for our patients,' but they weren't sure it would actually reduce their costs because of that huge investment. They've been very pleasantly surprised that they are seeing a return on the investment.

"There are some things that we can start with that are less of an investment such as e-prescribing, and if we can reduce drug interactions and the harmful side effects of that it's an important first step. Right now our members, such as McKesso - probably the largest health information technology provider in the world - are working hard to develop the standards and make these systems interoperable but in a way that still will protect the need to innovate so you don't develop a system and then stop progressing."

The number of those council members at the forefront of technological innovation is multiple. Grealy points to the work of Mayo Clinic and Baylor Health System, as well as the work of one of its smaller organizations, Northshore University Health System, a three-hospital not-for-profit system which has won awards for being a leader in this field. "There was the leadership under CEO Mark Neaman, taking it all and making the commitment that you're going to do it and then also involving their physician leaders in the development of that system.

"A great example of this is the issue of hospital-acquired infections, because they have electronic records and they're screening their patients as they come in. They know immediately what they need to do and they're able to act quickly - they have rapid testing, they have the results. It really is phenomenal the improvements you can make in treatment as a result of having that quickly and widely available

"Congress has sent a clear signal and probably the public is going to be sending a clear signal that this has to be addressed and we have seen where hospitals have taken this on. Again, it takes leadership, it takes the entire workforce in the hospital as well as their affiliated physicians - everyone committed to reducing those hospital-acquired infections. One of our concerns has been that we need to do this in a positive way, not a punitive way.

"If we do it in a punitive way then you start encouraging people, perhaps, to use antibiotics out of the box when maybe they're not indicated, so there really has to be a correct balance there; not penalizing hospitals in instances where perhaps that patient already had the infection when they entered the hospital, or they may develop it after they leave the hospital.Our members are committed, obviously, to solving this problem and there are ways to do it, but it's important that it be done in a collaborative way between government and the private sector."

Data protection

The Healthcare Leadership Council's work with the government, providing collaborative insight into legislation has awarded them achievements, such as the Genetic Information Non-Discrimination Act. Grealy notes the work that the council has done on the confidentiality of medical information, specializing in the genetic area.

"As a result of the human genome project, we are on the verge of being able to diagnose and, more importantly, to individually target therapies for people," she says. However, she is quick to point out the concerns with the potential opportunities for discrimination when using medical information - be it employment or health insurance coverage - laying fault with healthcare providers and researchers for not providing sufficient knowledge to the public as to how this will benefit them. Moreover how institutions will protect that information.

"So how do we find that balance between the need to assure people their information is protected and that they will not be discriminated against whilst making sure we have information available to provide them with the right treatments at the right time whether we're talking about drug interaction or the right cancer therapy for them? And then how are we going to use that information to also develop new treatments and new drugs?

"So we agree it's very important that people not be discriminated against, the information be protected, but what you also want to make sure of is that as we develop electronic health records and have access to much larger databases, emphasize that the information is anonymous but held by researchers to use and develop better treatments in the future.

"If we don't assure patients and employees that we're protecting it and that it won't be used against them, then we're not going to get that information, so that's our responsibility, as well as employers, health plan, hospitals and others to make sure that they protect that information. There are severe penalties for anyone who misuses that information but my biggest fear is that there are interest groups out there that just want to shut down all access to this information and that would be very bad for patients," she says.

Grealy's passion and dedication to her work has brought her personal achievements, too. Women in Healthcare recently named her one of its top 25 women in healthcare for her work in the council and Washington. On the importance of women representing healthcare issues she is firmly supportive of their role: "If you look at the statistics, the people that are making decisions about healthcare for their families are, by and large, women. And so they play a very important role in what treatments or coverage their family's going to engage in.

"In terms of Washington, women are great problem solvers but more importantly they're also great at collaborating and networking and working together to find solutions, and so that's another place that they can play an important role, it's is just a slightly different tone perhaps."

Collaboration is most certainly Grealy's skill, unifying different agenda groups for the sole purpose of bettering the healthcare system. It will still be some time before electronic health records are implemented and the uninsured are fully covered, but there is no doubt that the

Healthcare Leadership Council will be canvassing patient causes every step of the way.

 

Mary Grealy is President of the Healthcare Leadership Council.