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Change is in the air. Many congressional and health-care leaders say it’s more likely than ever that Americans will see some revolutionary changes in health-care policy, beginning this year. Among the health-care leaders who share that belief is Ed Brown, CEO of The Iowa Clinic P.C. Brown also serves in a prominent national role as chairman of the American Medical Group Association (AMGA), which represents approximately 97,000 physicians. Collectively, the association’s members treat one out of every four Americans through multispecialty practices.

“I think there’s a growing consensus on both sides of the aisle that change needs to occur in the health-care-delivery system,” said Brown, who as an AMGA board member has been involved in health-care-reform discussions on the national level for the past several years. Brown served as chairman-elect in 2008 and began his term as the AMGA’s chairman on Jan. 1. Next year, he will serve as immediate past chairman.

Several factors have created a groundswell of support for change from groups such as the AMGA, among them the increasing number of uninsured or underinsured Americans, the prospect that health-care spending will double over the next seven years and a new presidential administration that promised significant reform, Brown said.

“It’s an opportunity for leadership, putting ourselves in the center of change rather than reacting and responding to it,” said Brown, who recently addressed the National Association of Health Underwriters’ national convention in Washington, D.C., on the topic of health-care reform. “It’s been my objective for the organization to find ourselves at the table as the discussions are taking place, and help our congressional leadership come up with solutions as opposed to serving as an obstacle to something happening, because something does need to happen.”

If the current rate of increases in health-care spending continues, by 2017 the nation’s cumulative medical bill will nearly double from the $2.4 trillion spent in 2007 to $4.3 trillion, according to estimates by the National Coalition on Health Care. That level of spending would consume about 20 percent of the U.S. gross domestic product (GDP), up from about 17 percent today, Most other industrialized nations spend 8 to 10 percent of their GDP on health care. “That is not a sustainable or acceptable growth for America if we’re going to be competitive on a global basis,” Brown said.

Shaping policy

Brown, who played an instrumental role in bringing together more than 80 Central Iowa physicians from a broad range of specialties to launch The Iowa Clinic in 1994, has served as CEO of the multispecialty group throughout its 15-year history. The clinic has since grown to more than 125 doctors and health-care providers in 30 specialties, with satellite locations in 25 communities throughout the state. In November, the clinic completed an 85,000-square-foot expansion that doubled the space in its University Avenue building in West Des Moines.

Prior to joining the clinic, Brown served as a senior executive in the managed care industry for more than 10 years, with positions at Humana Inc. and CIGNA Health Plans. He received a bachelor’s degree in nursing with an emphasis in business from the University of Evansville in Indiana and a master of health administration degree from Washington University in St. Louis.

Brown said he has long had an interest in public policy issues, which led to his current role with the AMGA. He served on the organization’s public policy advisory board before being asked to serve on the board of directors seven years ago.

The AMGA has been fortunate to have a continuing involvement in shaping health-care policy, Brown said.

For the past six years, the group has had a board member who serves on the Medicare Payment Advisory Commission (MedPAC), which recommends Medicare and Medicaid policies to Congress. “They’re extraordinarily influential, and for AMGA to have a couple of those positions has been great for us,” he said.

The AMGA has also actively participated in health-reform discussions with congressional leaders for the past two years. When it became clear that health-care reform would become a significant agenda item in the 2008 election, “we took it upon ourselves to identify what our platform items were, and we were out in front on that fairly early,” Brown said. “We were also meeting with representatives from the Senate Finance Committee, which has responsibility for the finance element of Medicare, as well as representatives of the House Ways and Means Committee, particularly the subcommittee on health.”

The most tangible element of reform so far has come through the American Recovery and Reinvestment Act signed by President Barack Obama in February, which makes available $17 billion in incentive payments to hospitals and doctors that implement electronic medical records over the next five years. Health-care providers that haven’t implemented those systems by 2014 would begin to be penalized through reduced Medicare reimbursements.

AMGA is in favor

Increasing the use of electronic medical records, which will help providers improve the quality of care, is an important initiative that the AMGA supports, Brown said.

“It is very expensive to put health information technology in place; smaller physician organizations across the country have found it prohibitive to put that kind of type of technology into their business,” he said. “So there had to be something there to jump-start that transition. Now, for larger groups that have already moved in that direction and invested a lot of money to get there, it’s a little bit like a carrot and a stick.”

Of the AMGA’s list of 11 health-care-reform principles, improving access to care is at the top, and addressing “fragmented and disaggregated care” is also among the top priorities, Brown said.

On average, a greater number of physicians in Iowa belong to or are affiliated with large health-care organizations than the rest of the country, and Brown said he believes that will be the trend for the rest of the nation in the future.

“About 20 percent of physicans around the country are part of larger health systems; I think you’ll see that number flip the other way, where 80 percent will be part of larger organized systems of care,” he said. “They may not be totally integrated, but they’ll have some tight association. And it’s very plausible that as we look toward the future, (Medicare Part A and Part B) payment systems in select areas will get consolidated where hospitals and physicians will have to collaborate to deliver that care in the most efficient way possible.”

Brown said he believes Iowa’s large share of doctors belonging to organized systems of care is a reason the state ranks 48th lowest in terms of health-care costs, yet is third highest in terms of best medical outcomes.

“As a matter of fact, if you look around at the states in the Midwest – Wisconsin, Minnesota, Iowa, Nebraska, the Dakotas and Montana – if the rest of the country practiced medicine like they do, the cost of medicine would be 30 percent less,” he said. “And that’s a big number. So the question we all have to ask ourselves is, why? Without having the data to analyze that, it becomes difficult to determine how we’re going to become the most cost-effective delivery system we need to serve the population of the United States. So it makes sense that we move toward (increased) health information technology in our country if we’re going to get more efficient in how we deliver care.”

Several “trial balloons” for more far-reaching reform have been floated, among them a white paper issued by Sen. Max Baucus, chairman of the Senate Finance Committee, which called for universal coverage through the creation of a nationwide health insurance pool.

Keep looking

“I would say AMGA does not look at or support a single-payer system,” Brown said. “It probably should be something that’s a combination of public and private. I think reform needs to occur both at the private insurance level as well as the public level, all with the objective of trying to figure out the most cost-effective way we can deliver health care and provide access to the providers of care.

“Another factor is dealing with the delivery system so that we can manage the untenable growth rate that we’re on today,” he said. Otherwise, “health care is destined to go through another set of reforms that will be more onerous. We have no choice but to figure out a way to deliver care to patients in a more cost-effective manner.

“I’ve said several times that I think that health care is at the dusk of its past, and it’s facing the dawn of its future. We may not be sure of what the future is just yet, but it’s going to be different than what we’ve had in the past.”

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