wfn.org | [PCUSANEWS] How the Board of Pensions intends to hold the line on

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Note #9034 from PCUSA NEWS to PRESBYNEWS:

05625 Nov. 22, 2005

Holding the line on healthcare costs

How the Board of Pensions intends to do more with less

Commentary by Edwin H. Shoaf, Jr., MD, director of The Board of Pensions

PHILADELPHIA - Why are healthcare costs so high in this country? Is the
Board of Pensions (BOP) doing anything to alleviate the problem? Is
there anything more it can do to moderate cost increases? How can it
enlist its members to help cut costs?

	Those were among the questions taken up by the BOP's healthcare
	committee during its Oct. 28 meeting here.

	The committee started by reviewing a series of articles titled
	"High and Rising Healthcare Costs," published in the Annals of
	Internal Medicine in May and June, in which Dr. Thomas Bodenheimer
	pointed out that the main contributors to such inflation are a
	lack of competition in the market and increasing utilization of
	expensive new technologies. He concluded that policy changes by
	government and large health insurers could help significantly
	on both counts.

	The board cannot influence the national situation, but has
	programs in place to alleviate their impact on BOP Medical
	Plan costs: group purchasing of medications through the Church
	Benefits Association; contracting with other denominations for
	services through Highmark Blue Cross/Blue Shield; and competitive
	negotiations on benefits. All these tactics bring competitive
	forces into play. The board also tries to control the use of
	expensive technologies through pre-test authorization reviews
	of CT, MRI and other such imaging services.

	Administrative costs are a heavy burden, too, according to
	Bodenheimer. In that area, the BOP's performance is exemplary. Its
	administrative costs are less than the industry benchmark of 8
	percent of  benefits delivered or of revenues.
The committee was especially interested in Bodenheimer's suggestions of
ways to involve individual plan members and their physicians in reducing
the rate of growth in expenses. The common theme of these ideas is the
substitution of lower-cost ambulatory care at earlier stages for later
higher-cost hospital and emergency care. Each year, the healthcare
committee reviews statistics from the 24-hour nurse advice line, Smart
Choices, demonstrating such dollar-wise substitutions.

	Demographic factors account for 6 percent to 7 percent of
	healthcare cost increases. Bodenheimer pointed out that patients
	with multiple risk factors often need higher-cost care, and that
	the national "epidemic of obesity" is a "cloud on the horizon"
	for healthcare providers. Under the banner of personal health
	stewardship, the BOP has introduced several programs to help
	plan members ameliorate risk factors related to lifestyles or
	inherited traits. Information on programs to help members stop
	smoking, lose weight, and lessen stress is available through
	the Web site, www.pensions.org. Moreover, the pilot program
	called Preventive Incentive, which encourages members to take
	advantage of covered, age-appropriate health maintenance exams,
	is proving popular in its first few months.

	Bodenheimer's research showed that patients who require repeated
	hospitalizations for chronic conditions are another major driver
	of rising costs. He cited disease-management programs as a
	way of improving health while avoiding repeated admissions to
	the hospital. Right now the BOP has such programs in place for
	diabetes and heart disease, and is evaluating other conditions
	that might be added. The healthcare committee has asked for a
	study of the feasibility of helping at-risk individuals make
	changes to prevent the development of chronic conditions.

	The board's Web site has a video on medical errors, a concern
	across the healthcare community. A complication resulting from
	a medical mistake often turns a low-cost medical encounter into
	a high-cost one. The board's video reviews several strategies
	plan members can use to help prevent medical errors and be active
	partners in every interaction with the healthcare delivery system.

	The healthcare committee also reviewed Bodenheimer's comments on
	inappropriate care. High-intensity care, involving a large number
	of physicians in a patient's care, is likely to be high-cost and
	to include inappropriate and even harmful elements. The best
	remedy may be shared decision-making, with patients actively
	involved in treatment decisions. Bodenheimer cited six studies
	in which shared decision-making was associated with a 21 percent
	to 44 percent reduction in invasive surgeries, without adverse
	outcomes.

	The BOP has long sought to engage plan members as active
	participants in their healthcare. Bodenheimer's analysis shows
	that high-quality shared decision-making requires higher levels
	of support, including information about care options and their
	consequences. The board is now trying to identify sources of
	such information as well as delivery systems.

	Healthcare costs are high and rising. The Board of Pensions cannot
	control the contributing factors at the national level. But it is
	doing all it can to see that its own plan participants receive
	the highest-quality and most cost-effective care. To that end,
	the board is committed to empowering members to partner with
	providers for better care and lower costs.

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