11/19/99 Talk at the Leonard Davis Institute
Building on his experience as both a practicing physician and corporate health care leader, Dr. K. James Ehlen shared his views of the future of the health system in a noontime seminar at LDI. In his presentation, Dr. Ehlen challenged the audience with two central questions: “What do we know today that will shape the health care system of tomorrow?” and “What have we learned from the past that can help us reshape the future?”
He began with a review of some of the forces at work in our present system. They include a deeply held belief that the individual should be in control of his or her own health care choices, a trend he called “consumerism”. This trend, coupled with the advent of new technologies, has resulted in extraordinary cost pressures within the system. New technologies, Dr. Ehlen stated, “can produce stunning results and will produce stunning costs.”
These cost pressures have led to payment and reimbursement policies that have produced frustrated physicians and dangerously low operating margins for hospitals. “If the system is going to improve itself, we must find a method for engaging physicians and other providers in producing solutions,” he noted. New market models, he said, must recognize the patient-doctor relationship as the center of decisionmaking and center of responsibility.
Part of the solution, Dr. Ehlen said, is effective and creative use of information capabilities to reinforce the “right” behaviors in each stakeholder (hospital, doctor, patient, plan). “The combination of a telephone line, a PC, and a television…will fundamentally change the way we manage and deliver health care. By connecting with individuals, health care consumers…medical advice and counsel becomes available on their terms, [making them] more accountable for their own actions and the choices they make.”
As an example, Dr. Ehlen mentioned a successful pilot program in Minnesota that improved care of patients with congestive heart failure. Through alignment of incentives among a medical clinic, a health plan, and a hospital system, readmission rates fell dramatically, patient satisfaction increased, and health care costs were reduced by about $500,000 per year. The key to this pilot, Dr. Ehlen noted, was the 24- hour availability of a nurse clinician who had online medical records on a laptop computer. Patients had much greater access to timely, relevant information about their care from a health professional who had their records—thus avoiding many emergency room visits and duplicate tests.
“We have today the capability of knowing what the right care is, who should provide it, and when and where that care should occur,” Dr. Ehlen said. However, these “best practices” are often not implemented because the health care system does not reinforce movement toward these kinds of improvements. He cited geographic variations in care and medical errors as instances in which “best practices” could result in substantial clinical improvement, cost savings and a better patient experience. “The death rate in the U.S. from medical errors is equivalent to a full 747 airliner crashing each day. Why aren’t we asking and doing more about this?” Dr. Ehlen asked.
Reducing the rate of medical mistakes, Dr. Ehlen stated, will mean changing the processes of care that lead to improved patient safety. “This will happen only with deeply committed leadership from physicians and other clinicians,” he explained.
Looking ahead, Dr. Ehlen said that the leaders of the future will need to make a commitment to improving the health of individuals and the health of communities. Addressing the underlying causes of illness, in many cases, will require that leaders reach across unnatural boundaries and create working relationships with public and private organizations, and even among competitors. Looking “upstream” means addressing issues such as tobacco and alcohol use, violence, and unsafe behaviors before they manifest themselves as heart disease, diabetes, homicide and suicide.
“We have the necessary components to dramatically change the way health care is delivered,” Dr. Ehlen stated. “Now we have to arrange the parts to work together.”
Dr. Ehlen ended his presentation with a quote from Yogi Berra: “The future ain’t what it used to be.”
Biosketch: K. James Ehlen, MD
K. James Ehlen, MD, is the co-founder and immediate past president of the Allina Health System, a not-for-profit integrated health system, dedicated to community health improvement.
Prior to Allina, Dr. Ehlen was chief executive officer of Medica which grew to become Minnesota's largest managed care organization under his leadership. Before venturing into corporate health care management, Dr. Ehlen was a practicing endocrinologist in Minneapolis for twelve years.
He currently serves on the
Health Forum Board as its vice-chairman, the VHA Foundation Board as its
chairman, and also serves on the Board of Directors of the MMI Companies.
He is the immediate past chairman of Minnesota Meeting, a Twin Cities based
venue for presentations by nationally
Dr. Ehlen holds a clinical professorship in the School of Medicine at the University of Minnesota in the Department of Medicine. He lectures at the University of Minnesota and the St. Thomas University.
An advocate for the community
and volunteer organizations, he has supported a variety of efforts focused
on community health improvement. A leader in business and community,
he takes pride in his role as visionary, teacher, consensus builder as
he applied these capabilities in his various
The Environment: A review of compelling forces in the environment that are provoking undeniable changes in the health system and how it will work.
The Future: A discussion of three facets of the health system and what kind of challenges and solutions to expect. These comments will focus on:
Market Reform and what needs to change
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