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Sierra Health Foundation sponsors regional work group by Michael Monasky Special to EGN Friday, October 21, 2011 Health care reform, al...

Sierra Health Foundation sponsors regional work group
by Michael Monasky
Special to EGN
Friday, October 21, 2011

Health care reform, alternately called ObamaCare, is in a transition period before it becomes fully implemented in 2014. Health care plans, providers, public and private agencies are all scrambling to meet reform goals incrementally. That means these stakeholders must plan for the plan.

Sierra Health Foundation (SHF) is a health advocacy group supported by $130 million in privately donated assets covering the California region east and north of Sacramento County, including a few counties to the south. SHF sent out a call for policymakers to visit on October 19, 2011, to discuss challenges to health care delivery and collaborate over measures required to make that delivery more complete.

The keynote speaker was Congressmember Doris Matsui and her presentation was titled “Creating a Shared Vision.” Health care she said is “personal but affects the community and the economy”, she declared. “Planning takes time, like pregnancy and childbirth.”

Matsui sees the need to create connections, a framework, and enhance the safety net model. “Sacramento is a city, a county, and a region”, she said, “and 2014 is's time we move forward, kicking cans together down the road to health care reform”.

The conference was replete with health care consultants. Nancy Shemick said that the process “should be evidence-based, an expansion of commercial health insurance.” Planning and marketing should include simplification and streamlining, inclusion of immigrants who are locked out, integration of behavioral health with primary care, expansion of Federally Qualified Health Care (FQHC), and creation of a medical home for each patient. Shemick also said that non-health factors, such as cultural and environmental must also be considered.

Marsha Regenstein, professor of health care policy planning at Georgetown University noted that that access, quality, and value were key components of the safety net. Dental health is the most neglected area.

Regenstein compared health care collaborations in various cities. Austin and St. Louis had low level cooperation, using a coordinating organization. Indianapolis and San Francisco utilized intermediate cooperation in their MedicAid managed care model. Brooklyn, NY, had the highest level of health care integration with an FQHC embodied in Lutheran Hospital.

The stakeholders broke into groups discussing challenges and barriers, then features and measures to meet the needs of transition to health care reform by 2014. There were many questions asked and declarations made.

Some health plans are avoiding federal monies to forgo excessive program expectations. Challenges include inadequate reimbursement rates for primary care, identification of willing safety net providers, lack of common vision, poor data exchange between health care providers and what Marty Keale, executive director of the Capitol Community Health Network, termed “fratricidal competition”, and a “need for commitment to work together”. Keale decried the lack of trust, various motives and business models, and the lack of transparency of health plans to primary care providers and patients.

Questions linger such as is public health a public safety issue? Is access to health care a human right? What role should practitioner input play in health care policy? What about the long history of annual, double-digit inflation in health care costs? How do health insurance industry profits fare in the future of health care reform? What broader definition of health can make costs go down and patient participation go up? Despite these uncertainties and many stakeholder disagreements, the conference opened the door to discussion, debate, and critique.

One thing is certain - although health care reform is a federal program, it meets reality at the local level.

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