Making sense of health-care change

As the U.S. government struggles to decide how to fix the country’s health-care systems, Dan Feinberg, director of Northeastern’s health informatics program, has a unique view of the road ahead.

Health informatics experts create ways to integrate innovative technology into the day-to-day care of individual patients. Regardless of the health-care approach that emerges, such experts will be in high demand.

Here, Feinberg offers his assessment of the reform landscape.

What are some of the reasons health-care reform measures are being slow to move through Congress?

There is fundamental disagreement over how much reform is necessary and how fast it should take effect, as well as disagreement over how much government should be involved in the solution.

When we talk about a public health plan, what are the most important things to focus on?

Universal primary care brings value. Coordinated care brings value. Paying for quality rather than procedures encourages value. Improving efficiency of care brings value.

But cutting costs by broadly cutting payments does not bring value. Nor does limiting care.

When we talk of public plans, people look north or overseas and talk about universal care and government-paid care as if they were the same thing. They should also look at the Veterans Administration, which is both government-paid, universal (within a certain population), and integrated.

How will the large investment in electronic medical records (EMR), which is part of the stimulus bill, help health care?

An EMR is a tool. Most of the real value will come from how we use the tool. If we can integrate delivery systems, coordinate care, and improve disease management using tools like this, then we will see real value and real savings.

For example, an EMR serves as a base for disease management systems, which keep disease in control before an expensive hospital visit is needed. This is an important part of what students learn in the health informatics program at Northeastern: the implementation of the technology, not just the technology itself.

Why are many well-regarded groups, like the American Medical Association, rejecting a proposed public health-care option?

Government, especially via Medicare and Medicaid, has historically tried to control costs by broadly cutting payments. New rules inspired by certain abuses were often so broad that even good utilization was financially penalized. This leaves doctors very wary of government involvement.

President Obama has faced criticism because his plan might give individuals with severe medical problems little to no coverage. How might these patients be better served?

We need to face the fact that a large number of people need a small bit of care and a small number of people need a large amount of care. That is how insurance works. But that makes people hear “socialism” and reject such coverage.

Better measurements—partly from electronic records—will confront us with the truth of what we spend, and this might create a political opening.

What do you predict will ultimately come of Obama’s health-care reform and push for universal health care?

With luck, the whole country will look like Massachusetts. As a state, we lead the nation in payment reform. We lead the nation in adoption of medical records and building coordinated-care systems around them. The major health-care providers in this area are a model of improving preventative care and disease management.