An unprecedented array of international health care experts descended on the University of Miami Jan. 12-14, 2011 for the second Global Business Forum, organized by the School of Business Administration. Altogether, nearly 1,000 people - those who provide care and those who pay for it, as well as researchers, regulators and investors - participated in an intensive debate about the future of health care.
Attendees packed venues throughout the University, with many sessions standing room only. In between sessions and at lunches and special cocktail receptions, participants informally discussed the research, ideas and predictions they had heard, while networking with peers who shared their interest in health care’s future.
The stakes were clear from the start. Kathleen Sebelius, the U.S. secretary of Health and Human Services, delivered the opening keynote speech, putting the nation’s health care challenges in stark business terms: Americans take 45 million avoidable sick days, the equivalent of 180,000 full-time employees being out sick for a year. She called health care reform “a chance to close our dramatic health disparities,
but also to produce a healthier workforce.” “Despite having the world’s best doctors, the finest hospitals, the best technology, we continue to lag behind the rest of the world [in health outcomes],” she said. “We live sicker and die younger than we should.” The consensus was that health care reform is here to stay, in some form or another. “Reform is not going to be repealed,” said James Forbes, global principal investments executive for Bank of America Merrill Lynch, during his keynote address. “It’s not going to happen, folks. That’s the political reality.”
The discussions centered largely on the opportunities presented by reform: to improve health, to improve the experience of receiving medical care, to cut costs, to raise quality and to make a profit. For businesses, reform opens the door for innovations that improve the cost and quality of care. For caregivers, it means trying new treatments and even entirely new approaches to keeping people healthy, treating them when they are ill and improving the quality of every stage of their life.
In 30 panel sessions, two signature panel sessions and five keynote presentations, the Global Business Forum covered a diverse range of topics related to the business of health care. Although the School organized the Forum under the auspices of Academic Director Steven G. Ullmann, director of the School’s programs in Health Sector Management and Policy, nearly every UM college and school contributed, as did the Arnold Center for Confluent Studies, The Launch Pad and the Lowe Art Museum. “All the schools participated, so that we have lots of different perspectives on the subject,” said Barbara E. Kahn, who left her post as dean of the School of Business shortly after the Forum, whose creation she had spearheaded. “And a topic like health care needs that kind of approach. It needs the cross-discipline approach.”
It is an approach that the School of Business has long taken with its programs in health sector management and policy. It has offered a specialized Executive MBA for more than 30 years, as well as a joint MD/MBA degree and undergraduate major in health care management.
Academia, business and health care also come together at the School’s Center for Health Sector Management and Policy. The Forum was an opportunity to share expertise from around the University with an even wider audience. “The Global Business Forum gives us tremendous visibility, not only in the United States but also in the world, as a real thought leader,” said Frances Aldrich Sevilla-Sacasa, interim dean of the School of Business.
UM President Donna E. Shalala noted it was the type of gathering that universities do best, adding that the University took a unique role in the health care debate by organizing the Forum, with the support of key sponsors including Blue Cross and Blue Shield of Florida and Bank of America Merrill Lynch. “We’re actually a convener of people to have serious discussions of serious problems. That’s what universities ought to do, not simply in the classroom, but using their convening authority to look at the business of health care,” Shalala said. “We invited high government officials and high business officials to come and have a dialogue with many health care professionals, as well as our students, our alumni, and people in our community.”
The response to those invitations was remarkable, bringing together a range of high-ranking executives, industry analysts, public policy makers, medical practitioners, and faculty and leading researchers from UM as well as other institutions. Top law enforcement officials even joined the discussion during a panel session on reducing health care fraud.
At another session, the heads of several major health care and insurance industry groups debated how health care will be paid for in the future. “This is the first time that anybody can ever remember that you had the head of the American Medical Association, the deputy head of the American Hospital Association, the head of America’s Health Insurance Plans, the head of the Healthcare Financial Management Association, sitting down at a table at the same time,” Ullmann said.
Attendees and sponsors alike were impressed by both the breadth and depth of the Forum’s experts. “It was an eclectic group of people from the industry who all touched, in some way, the business of health care. There are a lot of different perspectives,” said David L. Epstein, managing partner of Presidential Capital Partners, a UM Trustee and member of the School of Business Entrepreneurship Programs Advisory Board. For Brian Keeley, president and CEO of Baptist Health South Florida, one of the event’s plenary session sponsors, “the quality and credibility of the faculty and guest speakers were the highlight of this event.” Keeley is chairman of the School of Business advisory board for Health Sector Management and Policy programs.
HEALTH CARE IS CENTRAL TO COMPETITIVENESS
While the debate was lively, one thing everybody agreed on was that health care in the United States costs too much. “We’re on a trajectory that’s going to see us pretty soon devoting onefifth of our economy to health care, and pretty soon after that, one-quarter,” warned panelist Michael Tuffin, vice president of America’s Health Insurance Plans, which represents 1,300 health insurance companies.
“That’s not all bad,” he added. “If we’re consuming health care, people are choosing to spend money for lifesustaining and life-enhancing medical care. But we’re not getting enough for what we spend, and we’re on a path that is not sustainable. Other priorities, like defense and education, are just going to be swamped. There aren’t enough dollars to go around.”
Several people warned that the country’s competitiveness will suffer if it doesn’t find ways to at least slow the growth of health care costs. Jeffrey Immelt, CEO and chairman of General Electric, one of the nation’s largest companies, shared his own concerns as well as some of the ways that GE is trying to rein in costs. The company spends $3 billion annually on health care for employees and former employees, he said, and runs an $18 billion health care business. He was adamant that unless the U.S. can get a handle on health care costs, hiring will not pick up and unemployment will remain higher than Americans would like.
Immelt believes the recent reform legislation is just the first step in a process that will ultimately remake health care in the U.S. “No matter how old you are, we are going to be working on health care in the U.S. for the rest of our lives,” he said. “Big business has the most to lose if we don’t get it right.”
The experts debated a variety of ways to contain costs, from the radical to the common sense. Several suggested that the health care payment system must be completely upended, because the current fee-for-service model only encourages providers to order unnecessary tests, perform unnecessary operations and spend more time treating problems that could have been prevented; there is simply no incentive in that model to provide preventive care that can help patients avoid costly treatments later. “The savings physicians make by keeping patients out of the hospital actually increases the volume of care they give, and they are penalized for that,” said Cecil B. Wilson, president of the American Medical Association.
ATTACKING CHRONIC CONDITIONS
The dual problems of chronic disease and an aging population came up frequently, as participants offered ideas for cutting costs and improving care through prevention initiatives and new delivery methods. Current figures show that approximately 75 percent of health care spending is on chronic disease. Several pointed out that once a person reaches age 65, his or her health care costs rise to two and a half to three times what they were in the previous decade. As the oldest of the more than 74 million baby boomers begin to turn 65 this year, the nation’s health care system needs to be ready.
Preventive cardiologist Arthur Agatston, author of The South Beach Diet, pointed out that unfortunately, chronic conditions are not solely a problem for the elderly. Agatston, an associate professor of medicine at UM’s Miller School of Medicine, spoke with concern about the rising rates of diabetes and heart disease, in particular among younger generations, which threaten to lower life expectancy.
“There’s this continuing debate about what health care system to adopt. I can tell you that whether it’s a one-payer system, multi-payer system or market system, it doesn’t matter,” said Agatston in his keynote speech. “It’s going to be overwhelmed by chronic disease if we don’t make changes, particularly in the younger generation, today.” Education — of physicians, nurses and patients — got attention from several perspectives. Professors from the Miller School talked about new ways of training medical students, international nursing experts looked at how to fill a looming nursing gap, and educators and activists discussed ways to put children more in touch with healthy food and exercise.
Others approached education from a different perspective: the health care consumer. Several predicted that high-deductible, consumer-driven health plans — which can empower patients to help keep costs down — will be the only option for most people in the near future. Troyen Brennan, a physician and chief medical officer for pharmacy giant CVS Caremark, described several efforts by the company to educate health care consumers, including programs aimed at cutting costly hospital readmissions and prescribing drugs more effectively. But, he acknowledged, none of those efforts will dramatically cut costs. “The costs of health care are big. Providing access to health care to everyone in the United States is big and important,” he said. “To cut costs, you’ve got to do a lot of small things.”
Even as the nation focuses on cutting health care costs, there are opportunities for business, beginning with the Affordable Care Act. “Quite honestly, most … private equity firms view this as a tremendous opportunity,” Bank of America Merrill Lynch’s Forbes said. Technology-related ideas got the most attention, especially innovations that aim to improve care and cut costs. From telemedicine to nanotechnology, the potential to build a better and cheaper health care mousetrap is enormous. Researchers are trying to develop art and music therapies as cost-effective treatments for devastating injuries. New joint replacement devices, regenerative technologies to create living tissue to repair organs and gene-based personalized medicine were just a few of the areas that presenters explored.
Some believe the real game changer may be electronic medical records. Thought leaders in health care and information technology talked extensively about the ways in which electronic data have the potential to save lives and money. “If you have a solution, such as information technology, that can put more information in the hands of doctors [and contain costs], then you will have a successful business,” said Michael Mindlin, a health care investment analyst at Stelliam Investment Management. Alan Wheatley, a vice president at Humana, a national provider of insurance plans, believes that electronic medi cal records “will drive unbelievably improved quality of care and improved decision making.”
WHERE BUSINESS AND ACADEMIA MEET
For attendees, the diverse nature of topics covered at the Forum was part of the attraction, as was the opportunity to network with others from a variety of fields, to cross-pollinate ideas and explore potential business opportunities. Larry Green (BBA ’68) said he has been to universitysponsored forums around the country — many on the topic of health care — but he had never attended one nearly as comprehensive as this one. “I was extremely impressed with the level of panel members from every area,” said Green, chief product development officer for the nutraceuticals company PHX Partners. “It was an eye-opening experience.”
This was UM’s second Global Business Forum, following on its successful 2009 event. Both were organized under Kahn’s leadership. Even she was amazed by how much larger the 2011 Forum was. “The level of engagement is much higher,” she said. “People are really trying to work together to think of solutions to these problems.”