General Electric CEO Jeffrey Immelt '78 participated in two panels alongside health care experts and local employers on Tuesday, stressing the need to "conquer the blob" of health care and reform current systems of health care delivery. Immelt also served as the keynote speaker for Tuesday's "Accelerating Change for Delivery of High-Value Health Care" forum, hosted by the Dartmouth Center for Health Care Delivery Science in Cook Auditorium.
A reliance on metrics, which are standardized performance indicators that assess treatment and care, will prove key to establishing common ground between employers, employees, health care providers and government agencies, according to Immelt.
"Defining good metrics is really important to drive the right behavior amongst patients and doctors," Immelt said. "For an industry that has as many smart people as this industry has, we're not moving with any force of will."
Sustainable health care reform requires change on a local and not on a national level, according to Immelt. The private sector will also need to rethink its role as a "terrible consumer" of health care and become more involved in the decision-making process.
The sharing of "models, successes, experimentation and trial and error" among hospitals and health care centers, as well as innovation of both first-rate and cost-efficient technology, can help achieve affordability and encourage a market-based approach to health care, Immelt said.
"We're investing in really neat, high-end technology, but we're also investing in low-end, low-cost and low-price technology," he said. "Good health care companies will be investing on both ends of the barbell. The market is going to decide where they go, but if people want to buy low-cost systems, we're going to make them."
The event featured two panels, the first of which brought together employers and experts in health care provision. The panelists included Director of the Center for Health Care Delivery Science Al Mulley '70, Geisel School of Medicine professor Glyn Elwyn and Lucy Savitz, director of research and education at Intermountain Healthcare's Institute for Health Care Delivery Research. In addition to Immelt, King Arthur Flour President and CEO Steve Voigt, Dartmouth-Hitchcock Medical Center President and CEO James Weinstein and Barbara Couch, vice president of social responsibility at the metal-cutting technology company Hypertherm, related their experiences as employers.
Several of the panelists discussed the need for increased transparency and data sharing among different health care groups.
"We've been talking a lot but in a very insular fashion, only to each other in our own communities and not across the line," Savitz said. "If there are different sets of metrics for every community, it's not going to help you as an employer. There needs to be some level of federal communication."
Weinstein commended his fellow panelists for being open and willing to share data across these lines.
"Collaboration and cooperation are starting to occur because we do now see that the federal strategy is sustainable," he said. "We have to find these new relationships to get the data to inform federal and non-federal people of what's needed."
Policymakers need to become more responsive to patients' needs, according to Weinstein and Elwyn.
"Not only is it the right thing to do, but in most situations high costs will go down, litigation will go down, patient safety will go up, patients will love that you pay attention to what matters to them and doctors will get the satisfaction of getting their jobs right," Elwyn said.
Individual patients' stories are often powerful, and attention to detail can be coupled with broader reforms to the health care system, in turn creating a sustainable model.
Employers need health care providers to act more as "consultants," a paradigm common to other consumer-supplier relationships in which suppliers assist consumers in defining needs, Voigt said in an interview with The Dartmouth.
Voigt said he is ready to transform the panelists' ideas into action for himself and other small businesses, a move that will require "breaking out of the existing models" while maintaining good business practices and serving consumer needs, he said.
The second panel featured the same employers in addition to practicing doctors and medical professionals. Panelists included Srinivasan Aravind, who delivers decentralized optical care to patients in India through the Aravind Eye Care System, Iora Health President Rushika Fernandopulle and Geisel School professor Elizabeth Teisberg.
Only 5 percent of diabetes patients meet five metrics for proper care in the United States, a statistic that indicates an "enormous failure," Fernandopulle said. The problem lies in a lack of effective delivery mechanisms in the existing systems, he said.
"We need to help patients navigate the system and do the shared decision-making," he said. "Current primary care systems are fragmentary, reactive and under-resourced."
More effort and funding must be devoted to preventative primary care so that this can serve as a resource as a "lever" for the rest of the system, according to Fernandopulle. Such a change will require one-on-one discussions and increased expenditure on primary care from its current level, which amounts to 4 percent of the national health care budget.
"What everyone talks about is improvement, but perhaps what we really need is innovation," he said. "The way we build airplanes isn't to put wings on cars we simply build airplanes. We need to be able to manage chronic conditions better and keep people out of the downstream stuff."
Shifting the mindsets of patients and health care providers while implementing "new language in a new conversation" are the most important steps toward lasting change, Teisberg said in an interview with The Dartmouth.
Immelt said he is eager to experiment with models like Fernandopulle's primary care system when he begins opening on-site health care facilities at GE plants in the near future.
"In the end, we're looking to improve quality and lower cost, in the whole system and on the micro level," he said. "I think if we're allowing this important industry or social challenge to be mismanaged, we're going to end up with poor access, poor quality and poor outcomes, and that's bad for all of us.
Immelt visited Dartmouth last summer, and his participation in the "Leading Voices in Politics and Policy" strategic planning lecture series sparked protest from students, staff and faculty.
While no protestors attended Tuesday's event, history professor Russell Rickford said it is a "glaring inconsistency and glaring hypocrisy" for corporate leaders to discuss health care at Dartmouth when the College's own benefit package is "substandard."
"On one hand, Dartmouth is trying to position itself as a global leader in terms of health care, but on the other hand there's the contradiction that many of its own workers are really suffering with these inadequate benefits and inadequate health care," Rickford said. "It's audacious that leaders of some of the wealthiest corporations in the country and in the world, many of which have avoided paying any real taxes and which have been shuttling jobs out of the U.S. into the third world, would sit around the table discussing the mutual benefits between employers and employees regarding health care."
