Kaiser Permanente: Collaboration, commitment needed to control health care costs in Colorado (column) | SummitDaily.com

Kaiser Permanente: Collaboration, commitment needed to control health care costs in Colorado (column)

Brent Bowman and Mark Carvalho
Guest Column

In recent weeks, Summit County community leaders have weighed in on the high health care costs facing this community and potential solutions. These are important discussions.

The Centers for Medicare and Medicaid Services estimate that American health spending will reach nearly $5 trillion by 2021. Health care is too expensive.

Summit County residents know this well. This community faces some of the highest health care costs in the nation. And it’s not only health insurance. Hospital care is more expensive here than it is in Denver. According to the Colorado Total Health Cost and Geographic Study, the cost of outpatient care — including surgery, physical therapy and imaging — in the mountains is double that of the entire state. When you consider the high cost of living in the mountains and limited access to high-paying jobs, costly health care is another factor that makes it difficult to live here.

Our industry, insurers, physicians, pharmaceutical companies, hospitals and many others must do more to address rapidly rising health care costs.

Kaiser Permanente is dedicated to improving the health of our members and the communities we serve. Our mission played a central role in our decision to begin providing care and coverage in Summit and Eagle counties two years ago. We are pleased to offer a new health care option in a region of the state that, historically, has had limited choices.

To truly provide high-quality care, it must be affordable. The current American health care delivery system is fragmented. It is based on an outdated fee-for-service model that focuses on sick-care with incentives for providers that encourage more care instead of the right care. This system is a driver of high costs and research has shown that it doesn’t lead to better outcomes.

At Kaiser Permanente, we believe our integrated model puts patients first. Our providers and in-network physicians work together as a team to keep patients healthy. Physician salaries and incentives are driven by real health outcomes, such as helping patients with high blood pressure reach their goals and reducing hospital re-admissions.

We focus on providing the right care, at the right time, in the right place. Kaiser Permanente offers urgent care availability and opportunities for members to connect with their providers online or by phone at no additional cost. Meeting people where they are increases the likelihood that health concerns can be addressed immediately and more affordably.

Spiraling prescription drug prices also drive health care costs. A 2015 report from The Pew Charitable Trust found that specialty drug spending is expected to reach more than $400 billion by 2020. The pharmaceutical industry has a duty to be upfront about drug prices — from research and development costs to the prices of medications already stocked in pharmacies. Greater research and marketing that compares the effectiveness of various drugs will help create better understanding of cost and value.

Expensive care has no direct correlation to quality care. Outcomes matter. To be informed consumers, Coloradans should be able to access price data for health care in all areas of the state.

Open enrollment for Individual and Family plans is underway. For coverage beginning Jan. 1, plans must be renewed or purchased by Dec. 15, 2017. Organizations like the Family Intercultural and Resource Center are working hard to educate people on their options and enroll them in plans through Connect for Health Colorado.

For those who are looking to enroll, help is available. Nearly two thirds of Coloradans who purchase plans on the exchange are eligible for subsidies to help them pay for their coverage. Last year, more than 100,000 Coloradans received these subsidies. But many Summit County residents who are eligible for them haven’t enrolled in plans.

Ultimately, health care must be accessible for everyone. Tens of thousands of Coloradans gained new access to health care with the Affordable Care Act. This was a step in the right direction. We believe any changes to our nation’s health care laws should increase access to high-quality, affordable care and coverage for as many people as possible. That’s how we’ll be able to advance health care in this country.

Brent Bowman is the vice president for expansion markets at Kaiser Permanente Colorado. Mark Carvalho, M.D., is the vice president of care delivery of expansion markets at the Colorado Permanente Medical Group.

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