WesternU's Ray Symposium focuses on health care reform

Joshua Benner, PharmD, ScD, challenged Western University of Health Sciences students to make a difference in health care reform in his keynote message at the annual Ray Symposium.

The Ray Symposium, held April 12, 2012 on WesternU’s Pomona, Calif. campus, is organized by the College of Pharmacy and the Interprofessional Education Program in honor of Max Ray, MS, PharmD, Dean Emeritus of the College of Pharmacy. He joined WesternU as Professor of Pharmacy Practice and Director of the Center for Pharmacy Practice and Development in 1996, and served as Dean of the College of Pharmacy from 1999 to 2006.

The 2012 Ray Symposium was sponsored by AmerisourceBergen, Comprehensive Pharmacy Services, CVS and Ralphs Grocery Company.

Benner, president and CEO of RxAnte, Inc., and visiting scholar at the Brookings Institute, outlined the current state of U.S. health care, major themes of health care reform, and the role students will play in the health care system during his presentation, “Reforming Health Care: Policy, Politics, and Patient Care.”

The U.S. spent $2.4 trillion on health care in 2009 and $2.6 trillion in 2010. Spending is expected to increase to $4.4 trillion by 2018. The country is in a state of unsustainable spending growth, Benner said.

The U.S. needs to “bend the curve,” or change the trajectory of projected health care spending as a percentage of the country’s gross domestic product (GDP), he said.

“We want to keep health care spending in reasonable proportion of GDP,” Benner said. “The projected rate of growth of health care spending will reach almost half of GDP in 2082. What we spend on health care is a big problem and its rate of growth is a big problem.”

Health care spending varies by region, and higher health care spending does not yield better quality, he said. About 55 percent of patients get care that’s recommended to them by best practice guidelines, according to a study that appeared in the New England Journal of Medicine.

Health care reform is challenging because of the dichotomy of how health care is perceived. About 70 percent of Americans believe the current health care system meets their family’s needs. But only 24 percent believe the system meets the needs of most Americans.

“This is the paradox of reforming health care,” Benner said. “We all think the health care system meets our needs well, but we mostly all express frustration in how it meets the needs of other people. Imagine trying to make policy in this environment.”

The Brookings Institute, a nonprofit think tank, convened leading health economists to come up with health care reform recommendations. Their suggested steps to reduce health care spending growth and improve quality include:

– Invest in better information and better tools for measuring and improving care.

– Restructure some of the inefficiencies in the insurance market.

– Transition to accountable payment systems, which means paying health care providers and clinicians based on the value they deliver, not for volume of service.

– Provide direct support that would encourage better individual choices by patients.

The Affordable Care Act (ACA) includes some of these recommendations. It establishes a mandate that most legal residents in the U.S. need to buy health insurance or pay a penalty. It creates insurance exchanges through which certain individuals and families may receive federal subsidies. It significantly expands eligibility for Medicaid, and includes no fewer than 45 reforms aimed at changing how health care is delivered, Benner said.

Two years after it was signed into law, the ACA looks primarily like a coverage expansion bill with new rules about how insurance markets work, Benner said. The same experts who suggested how the bill should look said it is helpful, but is not enough to bend the cost curve and ensure high-quality innovative care gets to everybody who needs it, he said.

The U.S. Supreme Court is determining whether the individual insurance requirement, or mandate, is constitutional. Benner said he doesn’t know how the Supreme Court will rule, but change is coming regardless.

“No matter what happens with the Affordable Care Act, health care reform will continue because it has to,” he said. “We have a lot more work to do. Real health care reform has to happen.”

He concluded by giving students advice as they continue their training and begin their careers.

“It’s important as a health professional to keep an open mind and embrace … change,” Benner said. “Recognize that it’s healthy and it’s needed. View changes like the Affordable Care Act and other changes to law or policy as opportunities to improve health care.”

This health care system students are entering is going to reward professionals who seek accountability for patient outcomes and cost, he added.

“Take responsibility for that patient. If things go well, you benefit. If things don’t go well, you’re on the hook. That’s what accountability means in the health care system of the future,” Benner said.

Part of what’s happening in health care is a shakeout to determine who is going to be accountable for the quality and value of care in our country.

“As you finish your training and move on into practice, engage in and think about the health care system at all levels – the ‘sausage making,’ the policy, the politics,” Benner said. “Ask yourself once every year, ‘What am I doing to improve health care?’ And if you don’t have a good answer to that question, find one, and work for it. Because the health care system of tomorrow will reward you for it.”