Surgeon General, QualChoice CEO Say ‘Value Proposition’ Has To Change To Improve Health Care

QualChoice CEO Michael Stock and Arkansas Surgeon General Joe Thompson think health care reform in Arkansas and the U.S. needs more “skin in the game” from consumers before changes might improve efficiencies, costs or delivery.

Stock and Thompson both appeared at a health care roundtable discussion on this week's edition of Talk Business on Fox 16.

“One of the big problems we have with health care in this country is the basic economic model for how health care is purchased doesn't really work the way most other economic models work,” said Stock. “In health care, we have a consumer, Person A, who's getting services from a provider, Person B, but someone else, Person C, is paying for it. So the true value relationship between the consumer and the provider isn't really understood as well.”

Thompson said more cost-sharing from patients is needed to understand wellness, sickness and the relationship of health care users within the entire system.

“Even in our Medicaid program, to have some minimal cost-sharing so that individuals paid $1, $5, $10 for a visit, maybe even more to go to the emergency room,” Thompson said would be one way to improve the new federal law. “The other thing that I would try to align with is I think too often we're looking at short-term solutions. We need 'skin in the game' for staying healthy and not needing health care in the future.”

Both men agreed that the federal law, which was ruled constitutional by the U.S. Supreme Court last week, will bring hundreds of thousands of Arkansans into the health care system. How to treat those newcomers and how to pay for them is still in question.

“It's definitely going to increase access to care. Close to 600,000 people in Arkansas will have access now through the program,” said Stock. “The question is with the physician shortage as it is across the country, how difficult will it be for those people to get in to see doctors when they want to.”

“I think our health care system is at a tipping point,” said Thompson. “I think we have both Democrat and Republican leaders that are concerned about the federal fiscal budget, as well we should be.”

Thompson added that the controversial Medicaid expansion portion of the Supreme Court decision — which gives states an opt-out clause — will be debated in the coming months.

“The expansion of

Medicaid is 100% paid for by the federal government for the first several years and then it moves down to be a 90-10 match,” he said. “This is an enormous opportunity for the state to leverage its resources and to get care and access to financial insurance to 500,000 folks that have never had that opportunity.”

Several Arkansas legislators have already questioned how much the ultimate 10% state match could cost the state and some have said they will use this argument to block the federal law's implementation in Arkansas.

The court's ruling will re-open state debate on health insurance exchanges, which for months were stymied by GOP lawmakers who encouraged Beebe administration officials to wait on the Supreme Court decision.

Thompson said he thinks the exchanges will provide more choice to consumers. Stock said QualChoice views the concept of exchanges favorably, but is still nervous about details related to products and benefits, which have yet to be flushed out by federal rules and regs.

“It's going to be like an Expedia-dot-com for health care,” Stock said. “There are exchanges that exist in the country today and we participate in private-run exchanges right now, so its a good way to get access. It decreases the cost of distribution in delivering health care services to people. We're not opposed to the concept of an exchange.”

Stock and Thompson also discussed key aspects of state Medicaid reforms, which began implementation on July 1.

Thompson described the shift from a “fee for service” model to a “managed episodic care” approach to finding a “clinical quarterback” to coordinate health care costs in the Medicaid program for certain types of illnesses and treatments.

Stock, who contends health care stakeholders will have a big learning curve with the changes, says the new system holds a lot of promise to improve patient care and costs.

“We're really looking for defining outcomes up front and working on an agreed-upon outcome rather than just paying for every touch that a provider has with a patient,” said Stock. “We think it will allow providers to make determinations on improving efficiencies.”

There's much more on this subject from both guests. You can watch their full interview below.