As I prepared my reflections, two issues stood out to me – 1) It was still possible for members of the two-party system to find common ground, common solutions to common problems with civility (but there was evidence that the door was beginning to close), and 2) Health care reform was the dominant theme of the day.
Health Care Reform was on everyone’s agenda. Differing models were circulated at the state level and in Washington. Hope was in the air. Health care organizations had begun to change how they operated, and financing models were being tested. WHA had developed Wisconsin HealthNet
with these principles – universal coverage, delivery system restructure, and equitable financing. Governor Tommy Thompson was promoting his Health Care Partnership Plan. Insurance market reform proposals were on a parallel path. By late March 1994, the Wisconsin Legislature adjourned without passage of a bill. It would be many years before proposals of this magnitude would again be considered by the Wisconsin Legislature.
Attention now shifted to Washington (late March). President and Mrs. Clinton were working on their own Health Care Reform proposal. Their system design included universal coverage, capitated provider payments, consumer choice, employer accountability, universal coverage, best insurance practices (e.g. pre-existing condition coverage). As the calendar rolled forward, it became clear that the President and Mrs. Clinton were going to experience great difficulty getting their ideas adopted.
Back in Wisconsin, a new Cost Containment Commission began its short life in January 1994. By the end of April the Commission was embroiled in “meddling” health care structure changes. By year end consideration for repealing the Commission was being seriously considered in Governor Thompson’s 1995-96 budget proposal.
In May WHA appointed its first vice president of medical and professional affairs. This action reflected the hospital-physician teamwork necessary in the future as well the application of new quality management tools that hospitals were testing.
Other conversations competing for time on leadership’s agenda included the Department of Justice regarding antitrust, OCI regarding insurance markets and Department of Natural Resources regarding medical waste.
A Deloitte & Touche study published in mid-1994 reinforced the view that hospitals would be parts of integrated delivery systems with integrated information systems and new payment structures within two to five years. These predictions not only predicted change but also the pace of change. Dominant questions were:
What would be the nature of the physician and hospital relationships in the future?
What would the health care be governing boards of the future look like?
What will be the necessary managerial and leadership skill sets of future leaders?
It is clear that 1994 was a special time to be in health care management. WHA’s agenda was vibrant and laid the foundation for future work.