A solo open-sea sailor who likens the nation’s managed care system to a leaky boat is directing a new organization that he hopes will revolutionize America’s health care delivery system.
“When you are a hundred miles from shore and your boat develops a leak, which has happened to me, it is no time to start thinking about the kind of boat you really want,” says Brian Klepper of Atlantic Beach, FL.
Klepper, who has a doctorate in speech and language, uses the nautical analogy to help explain the goal of the new organization he heads, the Center for Practical Health Reform (CPHR). The group held a national organizational meeting in Jacksonville, FL in October, involving an advisory panel consisting of, what he termed as “creative thinkers”–physicians, CPAs, health plan executives, leaders in business and health care, including the National Business Coalition on Health. However, psychologists were among a sizable list of providers not included in the first round of meetings.
Klepper believes that the managed care system is broken, but not broken enough to be irreparable if certain corrective steps are taken. The new program would not seek to replace managed care with a national health care system, although it does call for universal health insurance coverage.
Given the huge sway the insurance industry holds over lawmakers, “pursuit of an ‘ideal’ health system is counter-productive and would be met with tremendous resistance from everyone involved,” Klepper said.
“This effort is about saving and improving the existing system. We believe that, at its core, the United States approach to health care is approximately right and worth saving. That said, saving it will require some fundamental changes,” he added.
Stabilizing the health system’s operational infrastructure will require discipline and accommodation by all the players, including payers, providers, patients and business, Klepper noted.
Driving the CPHR’s planning and focus are increasing health care costs that once were tamed by managed care, but now are out of control, he said. More and more Americans will be left without health coverage and those who do retain insurance will be asked to pay higher deductibles and premiums, Klepper said.
“A full-scale meltdown of American health care is not only possible, but probable,” Klepper said. “Rising premium costs and the cooling of the economy could result in more than doubling the 43 million who now lack coverage.”
“When the SUV crowd finds out it can’t afford insurance, this country will be in big trouble. That’s why the system needs to be fixed now,” he said.
Beginning in 2000 a group of insurance and health care professionals started putting together a list of principles it felt were necessary to adhere to if managed care were to survive. (See sidebar for the list of 10 principles.)
The two large goals of the center is a general streamlining of America’s current health system to improve access, quality and cost and to develop a well-considered health plan design that can be deployed, like a life raft, if the reformed system should begin to fail.
The center’s executive director said the effort to reach a national consensus on managed care reform could take as long as five years. He envisions a budget of more than $1 million annually to support the center’s work, which will include roundtable meetings throughout the United States in the next few years.
The center will rely on corporate, foundation and individual contributions to fund its work.
To date, Klepper has relied mostly on doctors, business and insurers to fund the center’s activities. He said he has not made connections with psychologists, but doesn’t see their concerns with managed care differing much with other health professions.
“I’d love to have a psychologist on the board, particularly one with a lot of money,” he said.
A lot of psychology practice, Klepper said, is a cottage industry, with many individual practitioners.
Despite studies that show fewer and fewer health care dollars are going to mental health, Klepper said he didn’t see that trend as a conspiracy against psychologists.
However, he said that as health care costs rise, more and more employers will probably reduce psychological benefits. Businesses will turn more and more to employee assistance programs, which Klepper said employers now see as more effective tools to treat mental health problems than more traditional forms of therapy.
“Everyone should have mental health coverage in some form, but employers want to know that there is a demonstrable benefit for all that money they are spending.”
Klepper said that psychology, as well as all health care professions, need to adhere to scientific methods.
“Data solve a lot of problems,” he said.
Klepper said modesty keeps him from thinking of the center as the “Jackson Hole Group of the 21st Century,” as some have dubbed it.
“I hope to avoid some of the mistakes the Jackson Hole Group made when they recommended ways to increase managed care competition,” he said.
The founder of the Jackson Hole Group, Paul M. Elwood Jr., M.D., told a University of California audience in October that he is contemplating reassembling some of the Jackson Hole Group to propose many of the same reforms now being advanced by CPHR.
Elwood said that the proposals the Jackson Hole Group advanced were sabotaged by the Clinton administration when persons knowledgeable about health care were excluded from discussions about the future of managed care.
“It demonstrated to managed care firms and insurers that Harry and Louise ads could beat the president of the United States. While we’ve learned a great deal about the realities and politics of health care reform, it will be much more difficult this time,” Elwood said.
For his part, Klepper the center’s goal is to make sure decisions about managed care reform are made by people who understand the health care system.
He said he has no intention of allowing the center’s goals to be co-opted by politicians and others who don’t already know how the system works.
Klepper said the nation’s concern about terrorism should not deter the center’s goals, although he is aware that there is always the danger that special interests groups will work against any change in the system.
Klepper is the co-founder of Healthcare Performance, Inc., a company which consults with and repairs healthcare organizations. He has been published in The New England Journal of Medicine and Modern Healthcare. He can be contacted at firstname.lastname@example.org; tel: 904/206-9643.