The Value of Experimentation in Improving Health Care in America–Blog by Carolyn Pare, Action Group president and CEO

The Value of Experimentation in Improving Health Care in America–Blog by Carolyn Pare, Action Group president and CEO

“What is the point of being alive if you don’t at least try to do something remarkable?”

John Green, best-selling author and one-half of the vlogbrothers*

For as many years as I have been working with the Action Group, first as an employer Board member and then as president and CEO, people from around the country have said to me, “You’re from Planet Minnesota. We can’t pursue the same reform opportunities in health care here (e.g., Texas, New York, Pennsylvania…) because our market is different.” My response is always the same: While tactics might need to be different because health care solutions work best when adapted to local values, culture, political climates, and community needs, ALL of us have the capacity to influence positive change through vision, political will, leadership, and tenacity.

So, it was with great optimism, interest and enthusiasm that I read of the Amazon, Berkshire Hathaway, JPMorgan Chase announcement about plans to create an independent company that will rein in health care costs for their employees. This is exactly what was happening in Minnesota when I first got involved in health care. Leaders of large corporations based in the Twin Cities took a very bold and different approach to health care purchasing.

Bottom line? Local executives and benefits professionals wanted to quit chasing year-over-year savings by switching to cheaper plans and, instead, find a way to pay health care providers (doctors) based on quality outcomes and solid, high-value relationships with patients (their employees). The result was a program called Choice Plus.

Value-based purchasing. Patient-reported outcomes. Transparent pricing. Quality ratings. Consumer-directed health care. Vertically integrated delivery systems. Total cost of care. Nationwide, all of these themes are now in play in one form or another in public and commercial sectors.  And, while I want to be careful not to overstate, I also want to be sure people understand that it was through the groundbreaking work of some very visionary and courageous corporate leaders, IN MINNESOTA, that these concepts became both tactics and products across the country. Yes, it took years, but it took. And even though affordability is becoming a bigger issue than ever, we know what we can do. What we now need is the political will.

Lessons learned

As the new employer group moves forward to reduce cost and improve value in health care, I hope they can use a few lessons we learned during our journey:

  • Partner with — rather than compete with — health insurers (and others).
    Driving fundamental change takes a long time and requires cooperation among all strategic partners. “Any employer coalition that ends up being viewed as a competitor and threat to the insurance industry’s core business interests is probably not going to win that battle over the long term,” observed Steve Wetzell, president and CEO of The Action Group’s precursor, the Buyers Health Care Action Group. Choice Plus simply couldn’t sustain itself, and employers moved on because it was so challenging. While it’s not an employer’s business to run a health plan, the collective work of health care purchasers can shape the market.
  • Choice Plus was well worth the effort.
    Much more than an experiment, a number of things that had never before been identified grew out of the Choice Plus model. For example:

    • Provider-determined price and performance commitments
    • Direct, value-based contracting with provider groups of all sizes to level the playing field
    • Tiered pricing, based on cost and quality measures
    • Cost and quality transparency for providers
    • Rewards for high-performing care systems
    • Enhanced sharing of best practices between provider groups to “raise all boats” and improve quality for everyone
    • Consumer-directed health care
    • Cost and quality transparency for consumers
    • Vertically integrated systems of care (i.e., either hospital or clinic) that led to the development of ACOs
    • Employer “co-op” approach
  • The goals of the entire supply chain must be aligned.
    As health care costs continue ballooning, the private insurance that covers most working Americans is in even greater crisis than it was back in the Choice Plus days. Higher and higher premiums provide increasingly inadequate coverage, revealing that the pricing mechanism for medical products and services is badly broken. When it comes to health care, competition simply isn’t working because each stakeholder in the supply chain has their own interests to protect, leading to fragmentation and inefficiency. Simply put, there are suppliers that need to make money, and consumers who need to save money. Until we migrate away from fee-for-service toward value-based pricing, ours will continue to be a system in disarray. The Action Group continues to press for alignment so all in the supply chain have the proper incentives to do the right thing.
  • The Institute for Clinical Systems Improvement (ICSI) arose from Choice Plus and continues to be a force in reducing variations in care outcomes.
    ICSI is a highly regarded independent, nonprofit health care improvement organization with member medical groups and hospitals, nonprofit health plan sponsors, and active connections with and board representation by employers and consumers. ICSI frequently partners with state health and public health agencies, professional health care associations, regional health collaboratives, and others in Minnesota and across the nation to redefine and redesign systems and the market. The Action Group actively supports ICSI and other local and national initiatives to reduce variations in care outcomes and costs to improve patient satisfaction.
  • “Shopping” for health care is complex and confusing for consumers.
    Just 12 percent of U.S. adults are considered to have “proficient health literacy” according to the U.S. Department of Health and Human Services. In fact, patient engagement and health literacy ranked among the top patient safety issues on ECRI Institute’s 2018 Top 10 Patient Safety Concerns for Healthcare Organizations. With significant impairment in being able to obtain, process and understand basic health information, it’s understandable that consumers had a difficult time grasping the ideas behind Choice Plus, namely, that high-cost care does not always signal high-quality care, and low-cost care does not always signal low-quality care. The idea of cost tiers was confounding, and employers and employees were also frustrated by tiers that were subject to change from year to year and financial barriers faced by patients whose doctors fell in high-cost tiers. Add to that the fact that there was (and still is) very little price transparency that enables consumers to shop and compare prices, quality and patient satisfaction and you’ve got a steep mountain to climb.

At The Action Group, we will continue to keep our sites set on improving life here on Planet Minnesota — and far beyond. We will do this by remaining singularly focused on health care, uniting employers around common issues, amplifying the voice of those who write the checks for health care, and improving patient experience and outcomes.

Together with our members and with all vested stakeholders, we will flex our political will and accomplish more than any of us can alone, just as our founding members envisioned.

From the Archives:

*John Green Health Care Vlogs:


Carolyn Pare is the President and CEO of the Minnesota Health Action Group.