By Kenneth Boivin, Class of 2016
“Healthcare is not making us healthier” – Dr. Jose Montero
The former Public Health Division Director at DHHS and now Vice President, Population Health and Health System Integration at Cheshire Medical Center /Dartmouth Hitchcock Keene, Dr. Jose Montero, presented the opportunity for a new healthcare system –one focused on wellness, value, quality, efficiency and accountability. Armed with data about costs, spending and outcomes, Dr. Montero demonstrated that “Healthcare is not making us healthier”. Approximately 90% of current spending is directed towards providing access to healthcare, yet improving access only has the potential to influence about 10% of health outcomes. Interestingly, there is little healthcare spending dedicated to Influencing healthy behaviors, which has the potential to affect roughly 50% of health outcomes. Our healthcare system remains focused on treating diseases by ensuring access to those in need. A new approach is needed if we expect to improve our own health and the health of those around us.
“Live free or die: Death is not the worst of evils” – Gen. John Stark
It was hard to foresee where our discussions would lead after reading the two opposing newspaper editorials included in our homework regarding end-of-life planning. One viewpoint focused on “paid death chats” mandated and funded under Obamacare; the other on the importance of end-of-life planning. Dr. Sanders Burstein, Medical Director, Dartmouth Hitchcock Nashua, covered the topic of advance care planning and shared his personal experiences regarding end-of-life planning in his family. On one hand, we would prefer to live a long and healthy life, but on the other there are many examples of medical intervention that needlessly prolongs suffering and pain when death is inevitable. An advance care directive is intended to make our end-of-life intentions clear to our loved ones and healthcare providers. Thanks to Dr. Burstein for providing us with something new and important to discuss with our families over Thanksgiving dinner.
“No health without mental health” – Dr. William Torrey
Mental health is often considered separately from physical health. Geoff Souther’s (Chief Operating Officer, NH Hospital) career as a mental health professional has spanned the transformation of the mental health system from an institutional system to a community-based system. What he learned over his 50-year career –change is inevitable, treatment works, there is hope/recovery is possible, and to treat everyone with dignity and respect–is as much a roadmap for the future as a reflection on his experiences. To further underscore the disconnect between primary healthcare and mental/behavioral health, we learned from Dr. William Torrey,Vice Chair Clinical Services, Dept. of Psychiatry, Dartmouth College, that treatments for psychiatric disorders have become more and more effective, but are less and less available to those in need. Dr. Torrey recommends integrating mental/behavioral health into primary care (which is readily accessible). This seems like a common sense solution, especially considering the societal and personal costs associated with not having accessible treatment options. The recent news that overdose deaths in NH may approach record levels this year underscores the need for further improvement to our mental/behavioral health systems.
‘We agree on basic things” – Alison Macdonald
We closed out the LNH Class of 2016 healthcare session with a panel discussion on healthcare policy.
Our panel consisted of policy representatives representing several perspectives: federal –Alison MacDonald, Senior Policy Advisor for Senator Jeanne Shaheen; State –Director of Health Law and Policy, UNH School of Law; provider –Matt Houde, Director of Government Relations, Dartmouth Hitchcock; and insurer–Lisa Guertin (LNH ’05), President, Anthem Blue Cross/Blue Shield of NH.
Some items that we might agree on included:
• Prior to the Affordable Care Act, (ACA) there was a compelling need for change,
• Under the ACA, transformative change has occurred,
• Healthcare is expensive and costs continue to rise,
• Insurers, providers and government are inexorably linked and interdependent due to revenue sources and regulations.
• Aspects of our healthcare system are irrational.
Some uncertainties included:
• Future changes to ACA through the ongoing legal and political process.
• Insurer participation (i.e., UnitedHealth).
• Cost effectiveness.
• State funding for the Medicaid expansion under ACA.
As is typical of any LNH session, we left significantly more informed on the issues and with the impression that there remains a need for change, effective solutions exist and are possible despite our many disagreements, and there remains a need for civil discourse among all stakeholders. Our health depends on it.