Curing Health Care
One of the most influential people in the health care industry, George Halvorson ‘68 does not shy away from detailing the failings of the U.S. health system.
Health care in America is badly organized, inconsistent, dysfunctional, sometimes brilliant, usually compassionate, too often wasteful, too often dangerous, and extremely expensive, the chairman and CEO of Kaiser Permanente charges in his latest book, “Health Care Will Not Reform Itself.”
With more than 30 years in health care management – many of those at the head of the country’s largest nonprofit health plan and health system – Halvorson should know. He has dedicated his life to studying the finances and delivery of health care, both domestically and internationally. The solution to the country’s health care ills, he has concluded, doesn’t rely on fancy technology or cuts to services.
It requires providing the right care at the right time.
Consider the following examples. Keeping congestive heart failure patients healthy at home instead of helping them return home from the hospital saves money. Overweight Americans who lose 15 pounds are 40 percent less likely to become diabetic, a group that spends roughly 32 percent of the total cost of Medicare.
“It sounds easy and it basically is,” Halvorson says.
To make it happen, he recommends universal coverage and better linking between caregivers and the patient medical records they keep.
Halvorson oversees Kaiser Permanente, an integrated managed care system based in Oakland, Calif., that serves more than 8.6 million members and generates $40 billion in annual revenue. Besides its size, however, what sets Kaiser Permanente apart is how it coordinates care among a series of doctors, nurses and other caregivers. By improving communication, whether in person or through electronic medical records, care often improves for patients, especially those with chronic conditions who account for nearly 70 percent of all health care costs in the country, Halvorson says.
As Americans debate what health reform in the country should look like, many are looking toward Kaiser Permanente as a model.
Last summer, President Obama held up Kaiser Permanente as an example of an organization that can make the entire health care system more efficient. Industry insiders also expect the nation’s model for health care will eventually follow that of Kaiser Permanente and a handful of other organizations like Mayo Clinic and Cleveland Clinic.
“Most of us expect the rest of the field will change to that way over time,” says Rich Umdenstock, president and CEO of the American Hospital Association. “The country now understands that although we provide wonderful medical care on a case-by-case instance, we can be more efficient and do better.”
Halvorson’s expertise in that area has attracted the attention of both domestic and international organizations. He has served as an adviser on health policy and finances to the governments of Uganda, Great Britain, Jamaica and Russia. He serves on the Institute of Medicine Task Force on Evidence Based Care and the Commonwealth Commission for a High Performing Health System. He also chaired the Governors’ Meetings for Healthcare at the 2009 World Economic Forum in Davos, Switzerland.
Not bad for a man who accidentally fell into the business of health care.
Halvorson grew up in Menahga, Minn., about 90 miles east of Moorhead. While at Concordia, Halvorson worked as a sportswriter at his hometown newspaper, the Menahga Messenger. He also reported at The Forum, edited the college’s literary magazine and interned at the Wall Street Journal.
After graduating, he pursued a graduate degree in business at the University of Minnesota. Looking for a job that would allow him to work while finishing his schooling, he applied to be an underwriter with BlueCross BlueShield of Minnesota. The position felt like a perfect fit for someone with five years of writing experience.
“I thought underwriter meant assistant writer,” Halvorson says. “I had never heard of one before.”
Those who interviewed the young man were deeply amused by his assumption, but impressed with his experience. They suggested he instead interview for a newly posted position – assistant director of advertising and public relations.
Once he was hired for the communication job, the head of actuarial and underwriting insisted that he learn more about the core business. She had Halvorson trained as an underwriter.
“It was brilliant on her part,” he says. “Once I understood the business, I could communicate better about that.”
To his great surprise, however, he also fell in love with the actuarial and underwriting theories that determine the risk of insuring a person, passions that would later serve him well in his rise as a giant in the health care industry.
Health care delivery in the U.S. is surprisingly inconsistent. A recent study by HealthGrades, an independent health care ratings organization, found that patients at highly rated hospitals had a 52 percent better chance of surviving compared with the U.S. hospital average. When HealthGrades looked at 17 procedures and diagnoses, it found there was nearly a 72 percent lower chance of dying in a five-star hospital compared to a one-star hospital.
“That’s scary,” Halvorson says and, yet, those discrepancies in health care services have been apparent to him since he moved from senior management positions within BlueCross BlueShield of Minnesota to HealthPartners, an integrated health care delivery system headquartered in Minneapolis, to Kaiser Permanente.
Without coordination, it’s difficult to track how patients are doing. For example, physicians and caregivers know a lot about how asthma care should be done, but don’t always have access to data that shows which children are receiving that care in a timely fashion, Halvorson says. Doctors seldom know if needed prescriptions are filled.
He became more outspoken on the issue after his father suffered a heart attack about 25 years ago. His parents called the hospital, which dispatched an ambulance. It took 45 minutes for the ambulance to arrive. Halvorson’s father died in the hospital parking lot.
“If they would’ve said to bring him in, he’d have been at the hospital within 10 minutes,” Halvorson says. “That got me talking more publicly about health care delivery and what we can do to make it better for everyone.”
Halvorson’s first book on health care reform arrived in bookstores two months after President Clinton’s health care reform efforts failed in the 1990s. Even though the timing was bad, he believed the U.S. could learn from other countries that achieved universal coverage, lowered health care costs and did it in ways that work for their own cultures and economies.
Simple solutions, however, stand in stark contrast to a fee-for-service system that often pays American caregivers more when care goes wrong. Halvorson doesn’t believe caregivers purposely provide bad care but, as he explains in his latest book, “bad care can be very profitable care.”
And he scoffs at critics of universal coverage who use anecdotes of slow service in Canada to make their case.
“Only Canada uses the Canadian model,” he says. “No other country does, but other countries have still achieved universal coverage. There’s no reason we can’t find our own model.”
With universal coverage, it will be easier for everyone to receive preventive care rather than treatment and it allows for better tracking of outcomes, Halvorson argues. At Kaiser, he is most proud of investing $4 billion in electronic medical records. More than 10 million patients now have their records in computers, meaning that all of their caregivers have access to the same information. It also provides data that allows the health system to follow patient outcomes and recommend ways to improve care. For example, Kaiser used its database to track the long-term impact of people using Vioxx for pain relief and uncovered serious outcomes for a number of patients. The drug ultimately was removed from the market.
That’s just one example of what can be accomplished if the country refocuses and reforms health care, Halvorson says. It’s about being well.
It’s that tenacity and continual search for better knowledge that has launched Halvorson to the forefront of health reform today, says Umdenstock of the American Hospital Association.
“He’s a student of health care delivery and finances and he’s a visionary,” says Umdenstock. “He’s got the breadth of experience and day-to-day living that spans the whole health care sector.”
Story: Erin Hemme Froslie / Photos: Submitted