Health Care Costs and St. Francis and Health Care Reform and Health Care & Life Sciences

St. Francis CEO organizing effort to heal state's health care

July 30, 2007

Bob Brody wants a vision to fix Indiana's broken health care system. But the leading proposals out there just won't do.

So the CEO of St. Francis Hospital and Health Centers is spearheading an emerging group of central Indiana health reformers who want to start a bottom-up process to develop alternative solutions to the state's--and possibly the nation's--health care crisis.

Coordinated by Indianapolis health care consultant Les Zwirn, this group so far is informal, with the unofficial name of Grassroots Health Reform Campaign of Indiana. So far, it includes about 20 participants from hospitals, physician offices, universities, health insurers and consumer advocacy groups.

Zwirn declined to name participants in the group. But he did say that St. Francis, St. Vincent Hospital and senior advocate AARP have committed support to the effort. The grass-roots group has made no formal invitations to other hospitals, or to civic, church or health care groups. But it hopes to do so.

"It will be a bottom-up reflection of what's important to the citizenry of the community and not a top-down, ideologically based, niche-protecting answer to the issues that we're dealing with," Brody said in an interview.

Brody insists there must be middle ground between the Medicare-for-all proposal of the political left and the unleash-market-forces proposal of the political right.

For Brody, his desire to change the health care system has been building over his nearly 11 years as CEO of St. Francis, the city's fourth-largest hospital system. A big spark came two years ago after he participated in a panel discussion with other health care executives.

"I ended that breakfast with an agenda--to start talking about the real issues," Brody said. "As an industry, we seem intent on making money rather than delivering services."

Last year, Brody joined St. Francis with six other Indiana hospitals to study the problems with health care in Indiana. The other hospitals were Bloomington, Major, Hancock Regional, Johnson Memorial, Rush Memorial and Columbus Regional.

They chipped in $75,000 and hired Zwirn to conduct an analysis. They created PowerPoint presentations and, with a little help from WFYI-TV Channel 20, a short video to drive home the urgency of the problem.

They made their materials available on the Web, through a similar grass-roots group based in Oregon. The Web site is www.wecandobetter.org.

Zwirn's slide presentation notes that health care costs in Indiana have run ahead of those in other Great Lakes states the past 25 years. On a compounded basis, health care costs in Indiana have increased 30 percent over the Great Lakes average.

Such extra inflation, Zwirn said, is now an extra barrier to economic development. It's a drag on businesses looking to come here, grow here or start here.

When Brody and Zwirn began discussing their findings with leaders in Indianapolis, the scope of their talks quickly became statewide. The campaign is now refining its plans and message, looking for funding and a staff.

It wants to kick off discussions in communities throughout Indiana. These talks could include local medical professionals, politicians, church leaders, business owners, workers and common citizens.

The grass-roots campaign hopes the discussions lead to agreement on two or three key reform proposals, which could lead to local and legislative actions. It also hopes to quantify local sentiments through straw polls at these discussions.

The first event in Indianapolis came July 13 when Brody spoke about the campaign before the Downtown Kiwanis Club.

The grass-roots group is the latest in a string of efforts to study and improve health care in Indiana. Libby Cierzniak, a partner at Baker & Daniels and lobbyist for health care clients, noted that no fewer than five state agencies, two state commissions, one study committee and one task force will examine various aspects of health care reform over the next few months.

The Indiana Family and Social Services Administration commissioned Indiana University researchers to conduct local forums and propose policies that could comprehensively reform Indiana's health care system.

What sets the grass-roots effort apart is that it is not ordered by the government. And it's aimed more at consensus-building for change rather than devising technical policy adjustments.

"I don't think we can have too much dialogue on this," Cierzniak said. If the grass-roots campaign successfully can gather and gauge input from communities throughout Indiana, she added, legislators would pay attention to its findings.

Julia Vaughn, health policy coordinator for Citizens Action Coalition of Indiana, also applauded the effort. But she said it would be difficult for Brody and other hospital CEOs to avoid shaping the group to reflect hospitals' interests.

"That's the challenge: Can they get beyond their own back yard?" said Vaughn, who supports a system of entirely government-paid health care. "It's a tremendous challenge for everybody that has a stake in [health care]."

Vaughn said she expects a true grass-roots effort at consensus-building ultimately would lead to support for a Medicare-for-all program.

The grass-roots group isn't embracing any solution at this point. Rather, it hopes to reframe the debate about health care reform.

One big number dominates the current debate: 45 million uninsured Americans. Indiana's share of those priced out of the health care system is 700,000.

But the uninsured are not the root problem, these reformers insist. Rather, the uninsured and the high costs that force them to go without health coverage are symptoms of a broken, obsolete system.

That system needs new rules so it can work better for everybody, said Zwirn, a former hospital executive who now runs his own firm, ZwirnConsulting.

Changing the rules at the government level would provide the necessary push and pull to change the business models of hospitals, doctors, drug companies and health insurers.

The grass-roots campaign hopes those changes lead to a medical system that focuses less on providing care to patients with acute illnesses and more on promoting holistic health and health education.

"This is an attempt to encourage everyone to get off the sidelines--particularly business leaders and community leaders and church leaders," Zwirn said. "Because the rules will be changed, but maybe not to the liking of Indiana communities."

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