The Healthcare Imperative Lowering Costs and Improving Outcomes: Workshop Series Summary (2010) / Chapter Skim
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14 The Policy Agenda
14 The Policy Agenda
Pages 455-472
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From page 455... ...
In her keynote address for the third workshop, Karen Davis of the Commonwealth Fund discusses priorities for policy options to achieve cost control and affordable coverage for all. She identifies the goals of health reform as slowing growth in health spending; creating incentives for providers to take broader accountability for patient care, outcomes, and resource use; providing rewards for improved care coordination among providers; and creating an infrastructure to support providers in improving quality and efficiency.
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From page 456... ...
Antos of the American Enterprise Institute surveyed the analytical framework used by CBO in developing estimates of various dimensions of health expenditures, in which he emphasized that CBO considers exclusively the impact of legislation on the federal budget. He also suggested that because important considerations such as the impacts of legislative proposals on private health spending and access to care are not considered in CBO cost estimates, CBO estimates provide important but incomplete guidance to policy makers on the financial impact of potential legislation.
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From page 457... ...
The difference between the United States and the countries with the lowest mortality rates amounts to 100,000 premature, potentially preventable deaths each year. In spite of unparalleled spending, if nothing changes, an estimated 61 million people will be uninsured in 2020, and over 30 million more will be underinsured, at risk of incurring medical bills they cannot afford and accumulating debt for healthcare expenses (U.S.
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From page 458... ...
Indeed, instead of acting early to stop the onset of diabetes or complications associated with diabetes, Medicare covers the costs of treating end-stage renal disease without incentivizing preventive treatment and chronic care management. A Commonwealth Fund-supported study of Medicare fee-for-service claims data for nearly 12 million Medicare beneficiaries discharged from a hospital in 2003 and 2004 found that one of five patients was readmitted within 30 days, and half of nonsurgical patients were rehospitalized without having seen an outpatient doctor in follow-up (Jencks et al., 2009)
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From page 459... ...
Administrative costs in private health plans are a higher share of insurance expenditures than are administrative costs in public insurance programs like Medicare and Medicaid. Administrative costs represent 12.2 percent of private health insurance expenditures, compared with 6.1 percent of public program expenditures (Collins et al., 2009)
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From page 460... ...
The second strategy involves aligning financial incentives to enhance value and achieve savings. Curbing rising costs requires fundamental payment reform that rewards physicians and other providers for achieving quality and moves us away from the current reliance on fee-for-service payment toward incentives for quality, bundled payments for episodes of care, or global rates for per patient care.
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From page 461... ...
Next, the system can facilitate appropriate care and manage chronic conditions through integrated delivery networks that provide a continuum of care or provide funding and technical assistance for statewide and community efforts to support and connect primary care and more specialized resources in informal or virtual networks. Third, leaders must promote more effective, efficient, and integrated healthcare delivery through adoption of more bundled payment approaches to paying for acute care over a period of time, with rewards for quality, outcomes, and patient-centered care, as well as rewards for efficiency tied to high performance.
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From page 462... ...
A June 2009 Commonwealth Fund publication titled Finding Resources for Health Reform and Bending the Health Care Cost Curve found that a wide range of policy options exist for achieving health system savings to help finance health reform (Nuzum et al., 2009)
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From page 463... ...
Fundamental payment reform Perhaps most importantly, Medicare, Medicaid, and private and public plans participating in a health insurance exchange should all incorporate effective innovative payment methods as soon as those have been tested in a rapid-cycle process by a center on payment innovation. The center on payment innovation should be charged with testing systemwide payment reform, including Medicaid and private payers, and granting state waivers for systemwide cost containment initiatives and harmonization of public and private payment.
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From page 464... ...
Goals and targets Goals for health reform should explicitly be included in the legislation and a system instituted for monitoring progress toward those goals. Goals should include achievable goals by 2020 for share of population covered by health insurance meeting an affordability standard; bending the healthcare cost curve; share of population receiving care from patientcentered medical homes and accountable care organizations; performance on quality, safety, and disparities in care; and health outcomes.
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From page 465... ...
The essential elements of reform include opening a center on delivery and payment system innovation; rapidcycle multipayer innovations in Medicare, Medicaid, other state payers, and private payers; and harmonization of public and private payment in Medicare, Medicaid, a public/co-op plan, and private plans. Fundamental payment reform can be brought about by accountable care organizations, medical homes, bundled hospital acute care, transitional care, and follow-on care.
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From page 466... ...
CBO's Role CBO is a congressional agency mandated to provide Congress with objective, nonpartisan, and timely analyses to aid in economic and budgetary decisions on the wide array of programs covered by the federal budget. CBO also provides information and estimates required for the congressional budget process.
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From page 467... ...
based on peer-reviewed literature published in health policy, economic, medical, and other journals; unpublished studies from reputable sources; direct observation of trends in the healthcare market; comparisons with previous analyses by CBO and others of similar proposals; and consultation with experts, including staff from CMS, insurance actuaries, medical leaders, academics, and others. The cost of many proposals can be estimated in a straightforward manner, but some present greater challenges to CBO analysis.
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From page 468... ...
In the case of a long-established policy approach, the uncertainty is minimal. Example: Prevention An example of a more difficult estimate is a proposal to expand the use of clinical preventive services, including immunizations and other medical interventions to prevent disease ("primary prevention")
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From page 469... ...
Conclusion CBO scoring will continue to play a critical role as Congress debates major reforms in health care and other policy areas. Although cost estimates are presented in very precise numerical terms, they are subject to uncertainty and depend critically on how CBO analysts interpret legislative language and previous studies and data relating to the specific proposal.
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From page 470... ...
. The Commonwealth Fund Commission on a High Performance Health System.
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From page 471... ...
2009. Finding Resources for Health Reform and Bending the Health Care Cost Curve.
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