Approximately 41 million Americans have no health insurance. Countless more are underinsured. And many who are insured face quality and service problems related to managed care and access.

Change is needed, say many health-care experts. But exactly how to solve the nation's health-care problems isn't particularly clear-cut. Should there be a complete overhaul of the system? Would a combination of public and private approaches to health care work best? Should there be national health coverage? Experts are increasingly looking for answers from those in the best position to provide them: health-care users.

"Everyone agrees that the ways we've tried to solve problems in health care haven't worked," says Russ Newman, PhD, JD, APA's executive director for practice. But, he adds, there hasn't been much agreement from health-care and political leaders on new directions.

It was this recognition of the need to involve consumers and stakeholders that led to the development of the Wye River Group on Health Care, which APA sponsors along with groups such as the American Association of Retired Persons, IBM, the White House Council of Economic Advisors, the American Cancer Society and Motorola. Wye River Group, essentially a health-care "think tank," was founded by Chief Executive Officer Jon Comola, a health-care analyst, about five years ago.

"Wye is really about a process," says Comola. The group seeks to shepherd constructive change by bringing together local health-care stakeholders in communities around the country. To do this, the group is holding roundtable meetings with local representatives--eight of which had taken place at Monitor press time. "This isn't about us having a solution," explains Comola. "The idea is to define the problem--which is a different approach to what policy usually is."

Each meeting gathers approximately 25 local representatives, such as physicians, psychologists and allied health professionals. Some community leaders are chosen by sponsors and the rest are invited--after initial research in the community--by Comola and Marcia Comstock, MD, Wye River's chief operating officer. Psychologists are involved through APA's sponsorship and, depending on the location, as a result of the advance legwork to determine stakeholders.

"They really do their homework to find out who the stakeholders in each community are and then to find out what the issues [related to health care in each community] are," says Newman. Sally Cameron, executive director for the North Carolina Psychological Association, attended a meeting recently and says she was impressed with "the far-reaching discussion with a wide variety of players in the health-care arena."

Some of the key points from a roundtable meeting in San Diego included fragmentation of the health-care system in that community--"an obstacle to accessing psychological care," Newman notes--and the issue of prevention. And in North Carolina, Cameron's group also focused on prevention. "Several other participants resonated the concern for prevention of disease, including the mental health aspects of prevention," she says.

"For us, that's important because so many different health problems have major behavioral or psychological components," Newman says. "There's a big role for psychologists to play."

Sarah Brennan, PhD, a psychologist in New Mexico, attended a meeting in Albuquerque that she says had diverse representation from the public and private sectors. Her group also complained that care in New Mexico is fragmented. "We also really emphasized getting consumers more involved in the input of what's needed and what's lacking in health care," she adds.

In fact, now that it's finalizing the first phase of roundtable meetings to gather recommendations from communities, Wye River is preparing to launch the second phase: getting consumers involved. One initial finding of a January midproject report was that public awareness is essential to the success of any change to the health-care system. To this end, Comola asked several major public relations firms to present their ideas for how to create public awareness and buy-in. One group will be chosen to put together a public-education campaign following the final project meeting in July.

Involving the public is really a ground-up approach to changing the health-care system, says Newman. "What's been missing [from previous health-care reform attempts] in order to really get things done has been real involvement by consumers." In fact, Newman and Comola agree that making the public aware of the need for change and then incorporating their demands into any solution is a critical issue.

The mid project report also identified several more themes from the meetings, including:

  • Solutions must be collaborative, rather than the typical contrasting visions of private, competitive models versus government-managed models of health care.

  • Resources and incentives must be balanced to provide a greater emphasis on preventive and efficient care.

  • Health care must be equitable and must meet the needs of the medically disenfranchised.

* Infrastructure and administrative weaknesses must be fixed to facilitate coordination of care among providers--both public and private.

"There's no guarantee that this will result in a new approach to health care," Newman says. "But it's a good process, and it has the potential to come up with something that could be implemented."

Comola certainly hopes so. If national leaders' involvement is any indication, the outcome for creating some type of change looks good. The White House Council of Economic Advisors and the U.S. Chamber of Commerce have representatives at every meeting, and Sen. Joe Lieberman (D-Conn.)--a presidential hopeful in 2004--as well as Senate Majority Leader Bill Frist (R-Tenn.) have been involved.

"We told the sponsors and the White House we don't know exactly what recommendations will come out of this," says Comola. "But it will be true to a process with great integrity and diversity. We'll capture what is said in each community at an arm's length fashion."

This article is the first in an ongoing series on health-care reform.