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23 Common Themes and Next Steps
Pages 619-632

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From page 619...
... Orszag, in his keynote address in Understanding the Targets, explained that federal spending on just Medicare and Medicaid would grow to unprecedented levels over the coming decades if cost growth continued at uncontrolled levels. He highlighted that Medicare spending per capita by hospital referral region varied more than threefold -- from $5,000 to over $16,000 -- and 9
From page 620...
... 20 THE HEALTHCARE IMPERATIVE BOX 23-1 Common Themes Cost and outcome challenges • Health cost excesses with personal, institutional, and national consequences • Health outcomes far short of expectations • Fragmented decision points, inconsistent principles, political distortions Drivers of the shortfalls • Scientific uncertainty • Perverse economic and practice incentives • System fragmentation • Opacity as to cost, quality, outcomes • Changes in the population's health status • Lack of patient engagement in decisions • Underinvestment in population health Levers to address the drivers • Streamlined and harmonized health insurance regulation • Administrative simplification and consistency • Payment redesign to focus incentives on results and value • Quality and consistency in treatment, with a focus on the medically complex • Evidence that is timely, independent, and understandable • Transparency requirements as to cost, quality, and outcomes • Clinical records that are reliable, sharable, and secure • Data that are protected but accessible for continuous learning • Culture and activities framed by patient perspective • Medical liability reform • Prevention at the personal and population levels that this very substantial variation in cost per beneficiary in Medicare is not correlated with overall health outcomes -- and, in fact, that the opposite may be the case. Describing the relationship between growing healthcare costs and other sectors of the economy, he also discussed how increasing demands placed on states by Medicaid costs have crowded out other state priorities and limited growth in state appropriations for public education, putting, for example, public universities at risk and at clear competitive disadvantage with their private counterparts in faculty recruitment.
From page 621...
... . Fragmented Decision Points, Inconsistent Principles, Political Distortions Clear from the discussions was the multifaceted nature of the problem, ranging from poor care coordination, lack of consistent evidence-based guidelines, and medical errors resulting from multiple handoffs, to inconsistencies in the policies of health insurance regulators, payment systems that encourage volume over value, and political influences that sometimes overturn scientific determinations.
From page 622...
... . Perverse Economic and Practice Incentives Various attendees cited the current, predominantly fee-for-service reimbursement system as providing perverse incentives, rewarding volume of services over the delivery of high-value services.
From page 623...
... , with consequences for diabetes, heart disease, hypertension, cancer, and osteoarthritis. In conjunction with an aging population, several attendees suggested that the changing demography of the nation's health precipitated the need to increase prevention efforts, lower the prevalence of obesity, and facilitate management of multiple co-occurring and increasingly complex chronic conditions.
From page 624...
... Streamlining approaches intended to foster simplification through regional approaches and national guidelines and standards have had burgeoning success with public–private partnerships but still have underrealized potential (Healthcare Administration Simplification Coalition, 2009; IBM Global Business Services, 2009)
From page 625...
... Consideration of a proposed Independent Medicare Advisory Council to issue recommendations for Medicare payment updates and broader reforms that would not increase the aggregate level of net Medicare expenditures (Orszag, 2009) was discussed as a possibility, as were incentives for team care, provider integration, and patient involvement.
From page 626...
... The attention and resources dedicated to health information technology in recent legislation reflect the significant potential for electronic health records (EHRs) to facilitate care coordination and minimize medical errors (CBO, 2008)
From page 627...
... Yet, not only for patient satisfaction, but for better patient outcomes, the lens has to focus on patient perspectives and needs. Several participants suggested that shared decision making utilizes patient-centric decision aids that have been demonstrated not only to facilitate patient engagement and understanding in an informed decisionmaking process, but additionally to ensure that the personal preferences of patients are reflected in the ultimate treatment choice.
From page 628...
... Given the reality of abundant challenges and resistance to change, attendees suggested that ef forts to successfully control cost growth and lower spending while preserving innovation and outcomes could be achieved only with the cooperative efforts of the myriad stakeholders in health care -- including patients, providers, manufacturers, payers, regulators, researchers, and policy makers, in both the private and the public sectors -- aligning to improve insights, accelerate progress, and cre ate a system grounded in delivering value to its constituents. • Informing health reform initiatives.
From page 629...
... 2009. What does it cost physician practices to interact with health insurance plans?
From page 630...
... :369-376. Healthcare Administration Simplification Coalition.
From page 631...
... http:// www.mtlf.org/docs/31177/Wennberg.pdf (accessed October 2, 2009)


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