IN THE STATES: North Star State Shines Bright for Health Reform

We're always looking for real-life examples of low-cost, high-quality care. Minnesota is a good place to look, and the state's largest health plan is a good place to start. Patrick Geraghty, CEO of Blue Cross Blue Shield of Minnesota, took part in a NIHCM health policy forum in Washington this summer and presented the "Minnesota Experience." He suggested that the nation's leaders embrace the Minnesota model -- because it works.

"The discussion we are having as a nation is really not just about health care but it's about health. Wellness, prevention, and quality outcomes is really what we are collectively thinking about," Geraghty said. Positioning itself as a "health" -- as opposed to a "health care" -- company, Geraghty described BCBS's effective, "disruptive innovation" model for delivering care. Steps he called for include:

• Insurers should pay according to the quality of care delivered -- not by the volume of services performed. Paying for volume, he explains, produces volume. A system of global payments, bundled services, and pay-for-performance generates cost-effective care.
• The health care industry needs to be transparent. Consumers should have access to a care comparison tool, so they can evaluate providers, treatment patterns, and cost across the system. (Consumer-driven health care was born in Minnesota!)
• The medical community must establish evidence-based care guidelines. The entire health care community must be more collaborative and less competitive. Information and data are "critical community assets." By sharing best practices, the health care community gains as a whole. 
• Insurers need to incent and reward healthy behavior. For example, BCBS of Minnesota offers benefit plans where consumers get a premium reduction by successfully managing their numbers. As individuals work to improve their cholesterol, BMI etc., they are also working to lower their premiums. Results are encouraging.
• Insurers should tie benefit strategy to appropriate care models. For example, BCBS waives co-payments for the use of retail clinics. Minnesota is pioneering the retail clinic industry -- retail clinics provide low cost, high quality care.
• Insurers should take a comprehensive approach to prevention. For example, BCBS of Minnesota performs health risk assessments to tailor benefits to the individual. They offer smoking cessation programs, online coaching, phone coaching and various preventive care incentives. BCBS also works with employers to help them provide a healthy work environment, for example, consulting on vending machine/cafeterias food options and wellness programs.
• The health care system needs to be integrative. Hospitals in Minnesota, for example, own all their physicians, clinics, ancillary services, transportation services, home health care services, and rehabilitation services. In an integrated system, the hospital provides coordinated (and high quality) care to patients. Electronic health records, furthermore, facilitate a smooth, integrated system. 
• Geraghty not only suggests engaging the individual and employer -- but advises involving the community as well. Geraghty understands the social determinants of health -- and ensures that BCBS encourages health and wellness throughout the community. He argues that we need to "dig in" and tackle basic cost drivers such as obesity and tobacco. BCBS is a huge advocate for smoking cessation programs, sidewalks, bike paths etc. Their efforts have been successful -- Minnesota has a 17 percent smoking rate, the US has a smoking rate of 22 percent -- and BCBS of Minnesota has a 10.9 percent smoking rate.

As the nation debates the details of health care reform, Geraghty argued that we cannot fix the system with a "single bullet" but that progress is possible with a holistic, innovative, comprehensive strategy to change the system. He left us with this: "Minnesota has been a leader, is a leader, and looks to be a leader in the quality of care being delivered in this country. This is too big an issue to be a partisan political issue." We agree.