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| Gov. Tim Pawlenty's health care initiative, which he announced a year ago, has had only small success so far in its goal of making health care more affordable in the state. (MPR file photo) |
St. Paul, Minn. — (AP) - A year ago, Gov. Tim Pawlenty rolled out the "Smart Buy Alliance," promising to harness the "thundering power" of government, business and labor interests to push through improvements in health care and save money.
Today, the Republican governor points to small victories -- including a rare reprieve from rising health insurance premiums for state employees -- and says a full transformation of the health care system is three to five years away.
His vision: a world where a few mouse-clicks can connect consumers and employers to the best medical providers instead of mediocre rivals. Electronic records and claims speed everything up and eliminate time-consuming errors. Armed with information, patients make smarter choices that improve their health and slow runaway medical costs to a crawl.
"This is like turning a big aircraft carrier. It's not going to turn on a dime," Pawlenty said. "The bottom line is, we can show through the early returns here, through the state employee program, if you take these kinds of approaches you can save a lot of money, maintain quality and hopefully expand access."
But many in the business of health care say they have yet to feel much oomph from the initiative. They give Pawlenty credit for sketching out a vision of reform, but say there's still some distance to cover.
"I think it is a wise set of recommendations, but as near as I can tell, it doesn't have a lot of teeth," said Dr. Donald Jacobs, a trustee for the Minnesota Medical Association and head of Hennepin County Medical Center's physicians practice. "Down on the streets as it were, it hasn't affected us."
"It's still very much a work in progress," said Bruce Rueben, president of the Minnesota Hospital Association. "There's not yet a whole lot to check off the list at this point."
Expenses for the state's health insurers rose 7.4 percent last year - the slowest growth in seven years, but still well above inflation and wage increases.
Consumers were hit even harder, with out-of-pocket costs jumping 15 percent. At least there's a payback: Minnesota consistently ranks as the healthiest state or one of the healthiest states in the nation.
Cal Ludeman, who heads the Governor's Health Cabinet, said the Smart Buy Alliance had its greatest success in state government, which makes employees pay more out-of-pocket costs if they use more expensive health providers. The approach resulted in essentially no increase in health care premiums for 2006 -- the first time that's happened in about a decade.
Ludeman is confident that success will spill over to the private sector.
"I'd say we're halfway toward a major transformation," he said. "We've done much that we said we would do."
A critical piece of the Smart Buy Alliance's vision is the ability to compare health care providers, so government, employers and consumers can find the best. Ludeman says the group has spent the past year pushing for more information on quality and results.
This fall, alliance members can use a quality report on Minnesota health plans, eValue8, while shopping for 2006 contracts. They're also consulting a national patient safety report on hospitals, Leapfrog, to help pick providers.
"It's more information than purchasers have ever had," said Carolyn Pare, chief executive officer of the Buyers Health Care Action Group, which issued the eValue8 report.
But that report isn't much help to consumers, who are more worried about the performance of their doctor, clinic or hospital -- not health plan, said Peter Benner, a retired AFSCME union director who's been active in health care reform initiatives.
Consumers can turn to Minnesota Community Measurement, which ranked clinics on health issues ranging from asthma to women's health, and posted the results on the Internet earlier this month.
But the data covers only six major areas -- not every ailment.
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I think it is a wise set of recommendations, but as near as I can tell, it doesn't have a lot of teeth.
- Dr. Donald Jacobs, trustee of the Minnesota Medical Association
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Ludeman and Pare also can't say how many of the Smart Buy Alliance's members are using the information to decide where to spend their health care budgets.
The alliance's members include state government, the Minnesota Business Partnership, the Minnesota Chamber of Commerce and the Labor-Management Health Care Coalition of the Upper Midwest.
Benner says the group is too loose to bring about the kind of change Pawlenty promised.
"It is not sufficient for the governor now -- this governor or any other governor -- to say 'I'm going to form a very loose group of people to try to jawbone health care issues,' and expect anything to happen," Benner said. "If you're serious about this stuff, you've got to take very aggressive action."
Pawlenty is trying to change what one expert called a "non-system" - sprawling and governed by many masters.
As HealthPartners' director of credentialing, Marilee Forsberg oversees one small corner.
Each month, she helps the Bloomington-based insurer give its stamp of approval to as many as 150 doctors, dentists, podiatrists, nurse practitioners and physician assistants. Forsberg also keeps tabs on 20,000 health care professionals in the HealthPartners network.
It's a paper-intensive, time-consuming process that involves verifying licenses, medical school degrees and other qualifications and watching out for violations and malpractice cases.
"It's very difficult," Forsberg said. "There's a constant flow of information coming in."
HealthPartners and its rivals saved some money this year by sending just one staffer to check up on credentials on behalf of all five plans. That meant the Mayo Clinic had to haul out its personnel files once, not five times - saving time for everyone, Forsberg said.
It was a small step toward the streamlining Pawlenty called for. But the bigger change he sought -- a one-stop shop for health workers' credentials -- is unlikely.
Federal antitrust law requires each plan to make its own decisions about the professionals in its network, said Eileen Smith, spokeswoman for the Minnesota Council of Health Plans. She said the council may start an organization to verify credentials starting in 2007.
Pawlenty says he expects the health care initiative to pay off.
"It'll significantly slow down the cost increases and we hope into a range that is sustainable and reasonable," he said. "The current system is just broken. This system is going to crumble in the next 20 to 30 years with demographic changes."
(Copyright 2005 by The Associated Press. All Rights Reserved.)
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