Plenty of ideas for changing U.S. health care were aired Sunday at the Mayo Clinic Center for Innovation Transform 2014 symposium, which continues today.
They included more openness from providers about price and a focus on retail health care that makes it easier for patients to access care.
Most strikingly, the traditional way of paying for health-care services is not designed to handle advances like genomics, nanotechnology and digital technology, said Dr. Mark McClellan, former director of the Food and Drug Administration and the Centers for Medicare and Medicaid Services.
Such advances can extend life, but the initial cost is very expensive. But it's been shown that "people are wiling to spend $50,000 to $100,000 or more for another year of life," McClellan said.
Pressure is moving toward offering a bundled payment that includes all the costs for a particular treatment, including the physician, pharmacy and other services, McClellan said.
There are many challenges, but "there is a path forward for doing something about this," McClellan said.
"All of us are caught in a situation where the system doesn't work -- and there's tremendous frustration," said journalist and symposium moderatorJohn Hockenberry.
He set a goal of finding "tangible, concrete" steps from the symposium that attendees can take afterward to make a difference.
More than 300 people attended Sunday's early session, which was served by trolley shuttles to Mayo Clinic tours departing from the Civic Center venue every 10 minutes.
Included in the tours was Mayo's sesquicentennial display in the Peace Plaza, the Mayo Center for Innovation and the Mayo Simulation Center. More than 600 are registered to arrive by today and Transform 2014 continues through Tuesday afternoon.
Hockenberry said health care has become more personable, with providers getting to know patients instead of just their ailments.
But also, the business model is changing.Health providers have long tried to convince consumers to avoid the emergency room unless it's really an emergency.
But as urgent-care clinics pop up in shopping centers and grocery stores, it's become clear that "consumers like the idea of an emergency room."
"People want to be able to walk into an urgent-care facility of some description and get their problem taken care of," he said.
Clinics are becoming increasingly good at so-called "retail" health care, remedying simple medical problems and the associated paperwork so patients don't have to deal with the minutia of being sick -- but can instead focus on getting well again.
New York Times journalist Dr. Elisabeth Rosenthal shared examples with the audience from her series "Paying Till it Hurts." She expounded upon the many problems of the U.S. health-care system, noting she hoped to hear potential solutions from symposium attendees.
"Patients in this country are trying to make it work in a system that doesn't work," Rosenthal said.
She described a woman who ordered U.S. Food and Drug Administration-approved pills from Canada -- because such drugs cost a fraction in Canada of what they do in the U.S.
The woman's pills were impounded, and she was contacted by authorities for having committed a crime -- buying FDA-approved pills for which she has a medical need and having them delivered to the United States, where they were made and packaged.
So-called "reimportation" is something U.S. Sen. Amy Klobuchar said before her own symposium presentation that she is working on with Sen. John McCain to address. Klobuchar, a former prosecutor, wants to make it legal for U.S. residents to obtain FDA-approved drugs from Canada.
The biggest hurdles for health-care transformation, Klobuchar said, are lack of attention to NIH funding, government dysfunction such as the so-called fiscal cliff, global competition and difficulty recruiting talented individuals.
Rosenthal said medical supplies are problematic because some devices, such as glucometers for diabetes, are offered cheaply to patients. But the day-to-day supplies needed to use the devices are costly.
An MRI at a hospital might cost $5,000. At an outpatient center down the block, the same procedure might cost $500, Rosenthal said.
But California is the only state where hospitals are required to submit "charge master" prices to the state that show the prices for their procedures and other services.
"I always wonder why more states don't require hospitals to file these ... How can you be a good consumer if you can't get that information?" Rosenthal said.
McClellan, currently director of the Health Care Innovation and Value Initiative at The Brookings Institution, said movement away from fee-for-service payments and toward bundled services in which a certain amount is paid for, say, a hip replacement from start to finish, will need to increase if the rise in health-care costs is to be blunted, he said.
Nontraditional ways of providing health care, such as sending an email response to a patient's question instead of requiring an office visit, staying open late to offer clinic hours instead of emergency-room costs "are not reimbursed under traditional payment systems or reimbursement," McClellan said.
Taking a broader approach to health care, such as bundled payments offered by Accountable Care Organizations, means there's "going to be a permanent change in how health care is financed in the United States and elsewhere."
Mark Bertolini, CEO of Aetna, an insurance company serving about 44 million people, said "the retail nature of the health-care marketplace is going to happen -- and sooner than people may think."
His own son was diagnosed with T-cell lymphoma.
Bertolini had to devote himself to his son's care full time in order to fight on multiple fronts. For example, his son was given foods to which he is allergic. And his son's kidneys were damaged by the cure to his lymphoma (Bertolini donated one of his own).
The system is too complex, he said.
"It shouldn't be as hard as it is. You should be able to get care anywhere," he said.
But doctors deal with cash flow. Hospitals deal with revenue flow. Insurers deal with margin. All three should deal with the same thing -- operating margin -- meaning making a profit, Bertolini said.
As has been said about Mayo Clinic many times, "if you don't have margin, you don't have a mission," he said.
Each year when he prepares to pick which health-insurance plan he wants, "it's a quagmire for me -- and I run the company," Bertolini said. His company, he said, is working on offering a set deductible for all policyholders and a $10 copayment, regardless of the procedure to simplify and make things less confusing for consumers.
"Had I not made it my job to manage my son's care, he would be dead today," Bertolini said.