Dear President-elect Obama:

Congratulations on earning the world’s highest leadership honor. It was clear to me that when I first met you during your state senate career that you were destined for greatness. I am proud to have supported you in your bid for the White House. I am equally grateful to you for your support of my MedPAC nomination. While I was not appointed during this round, I hope to serve in that capacity in the future.

As the CEO of Iowa’s first and largest integrated health system, I write to offer, with humility, an on-the-ground perspective of what I believe the direction health-care reform should take in America. I also offer Iowa Health System as a demonstration site to illustrate how your health-care reform goals could be put into action. Some of your initiatives we have already put into place, and we’d be happy to share with the rest of the nation how we have done so.

Iowa Health System is uniquely positioned to assist your administration in modeling true health-care reform in our country. Iowa Health System, which is the seventh largest non-Catholic Health System in the nation, serves 1.8 million patient visits each year – many from rural Iowa, but also from our state’s larger communities such as the Quad-Cities, Cedar Rapids and Des Moines. We are uniquely positioned in middle America, serving seven large Iowa communities and Rock Island and Moline, Ill., 14 rural communities and seeing patients in group practices of physicians and clinics in 71 communities in Iowa, Illinois and Nebraska. We employ almost 20,000 health-care workers and have annual revenues of about $2 billion.

Why use Iowa Health System to model health reform goals? Iowa Health System is large and diverse enough to offer a fair demonstration in the areas of delivery, payment, access and electronic health record reform, yet integrated and consolidated enough to be a controlled group. Iowa, as documented by the Commonwealth Fund, is known nationwide for its high quality/low cost health-care services. The Iowa Legislature has recently passed, with the full support and leadership of Iowa Health System, dramatic state health reform legislation addressing the uninsured, medical home, prevention and wellness and electronic health records. Iowa has an aging population, and although the state is largely homogenous, pockets of Iowa and Illinois served by Iowa Health System facilities have a significant number of minorities. Iowa and Illinois, with the support of Sens. Dick Durbin, Tom Harkin and Chuck Grassley are well positioned in Congress to promote health reform initiatives.

With this backdrop, here is how Iowa Health System seeks to engage in the health reform goals of your administration:

(1)  Pilot the Advantages of the Electronic Medical Record - You have been a vocal proponent of the need to introduce new technology and the electronic medical record to assist health-care workers in preventing medical mistakes and save health-care dollars. You have stated a goal that hospitals and physician clinics be connected to each other through the Internet. Iowa Health System is currently modeling the use of electronic medical records through what we call HealthNet connect. It is a model, and we would like to be a demonstration site for the rest of the country. HealthNet connect is a health-care network designed by health-care professionals for health-care professionals. It is a 3,600-mile fiber optic network already in place and providing services to Iowa Health System's 11 largest hospitals and network of rural hospitals. Sixty-one of Iowa Health System’s 63 (96%) physician clinics have fully implemented the EMR and 63 of 63 (100%) of these clinics e-prescribe. The network operates at a 99.999 percent reliability rate and processes more than 8 million transactions per day. The network runs throughout Iowa and spans four states, with direct fiber connections to major metropolitan cities stretching from Denver to Chicago. The possibilities to expand services are tremendous. Plans call for HealthNet connect to provide the common backbone for state-wide medical records sharing, continuity of care documentation and inter-facility data transfers, as required by Iowa state law by 2010. Additional plans call for HealthNet connect to provide direct access to national research organizations for education, research and participation in clinical trials and to be accessible to a wide health-care user base, including private clinics, physicians, pharmacies, labs, payers and other entities in the health-care delivery cycle.

(2)  Pilot a New Health-Care Delivery System - As a health system that has been working on care integration for more than a decade, Iowa Health System supports movement of the health-care delivery system to a model of accountable health care organizations (ACO’s). This model calls for integrated care organizations (hospitals and physician groups) explicitly focused on a clinical culture that supports quality care, for which such organizations are evaluated, compared and held responsible.

Current Medicare volume growth is unsustainable, quality of care is uneven across the country and lack of care coordination is common. ACO’s are a mechanism that can counteract the incentive for volume growth and reward improved quality. ACO’s are responsible for all patients, not just those with multiple chronic conditions or those admitted to a hospital. The key incentives for ACO’s are to keep patients healthy and reduce hospital admissions.

Iowa Health System has designed a medical home model (primary care providers rendering comprehensive, preventive and coordinated care centered on patient needs, using health information technology and other process innovations to assure high quality, accessible and efficient care) which is a springboard for movement to an ACO. We seek to be chosen by CMS as a demonstration site to pilot a medical home model. We are also an ideal candidate to pilot an ACO care model in future CMS or other federal demonstration projects on health-care delivery reform.

* Iowa Health System’s chart of its medical home model is attached.

(3)  Pilot a New Medicare Reimbursement Model for Health Services -

We promote movement to a reimbursement system based on quality health-care outcomes for patients. The current payment system that rewards volume and increases utilization must be exchanged for one that manages patient care and achieves healthy outcomes for patients. Such a change only will be achieved by meaningful Value Based Purchasing legislation. We continue to work to standardize our clinical practices, improve efficiency, reduce our cost of care and eliminate errors and redundancies. However, in the end, we believe that value is reflected in quality outcomes for patients, not merely adherence to standardized practices. This requires definition to be given to the term “quality outcome,” whether that is a certain health status or an ability to perform defined bodily functions. We also believe concepts such as bundling and gain sharing will incent providers to coordinate care models. Payments to providers should be across care settings and across time frames of caring for illness. Movement to a Value Based Purchasing model also will repair a reimbursement system latent with geographic inequity. Quality outcomes in Iowa or South Dakota should not be reimbursed differently from quality outcomes in Louisiana or Texas. We welcome the opportunity to be part of a new payment model.

Thank you for your time and consideration of Iowa Health System as an incubator for health-care reform initiatives. It would be a privilege for me to discuss these concepts in more detail with your staff. On behalf of Iowa Health System, we look forward to embracing the change in health care that is beckoned by your administration and desperately needed by our citizens.

Respectfully,

Bill Leaver

President/CEO

Iowa Health System

cc:

Honorable Tom Daschle

Sen. Tom Harkin

Sen. Chuck Grassley

Sen. Dick Durbin