(1) How to make guaranteed issue, modified community rating, and other needed insurance market reforms work if the Supreme Court decides the individual mandate is indeed unconstitutional?

(2) How can Medicaid provider payment rates be increased without adding strain to tight state budget?

Courtesy of the Kaiser Family Foundation

Quality Care for Less Money: Can Regional Success Go National?

(Commentary on the Conference February 15, 2012 at the Kaiser Family Foundation in Washington, D.C.)

Elizabeth I. Flashner, MS, Colleen M. Tallant

                The innovation of health reform, demonstrated through several models across the country, has continued to motivate health care organizations in implementing more effective and cost-saving changes.  On February 15, the Kaiser Family Foundation hosted a meeting of some of the most influential players in the development of reform across the country.  The goal was both to unveil “U.S. Health Care: The Good News”(a documentary made for PBS), and share findings regarding the monumental reform tasks at hand: improve the health of the nation, improve the quality of that health care, while reducing costs.

Dr. Elliot Fisher, Professor of Medicine and Director, Population Health and Policy at Dartmouth Institute for Health Policy and Clinical Practice offered insight into some of the barriers we have faced to successful transitions.  Currently, health reform has the form of an “unseen goal” that is difficult for many to grasp and embrace.  Identifying the information needed to develop a reliable structure as well as access to that data has been an additional challenge for some environments.  Fisher also believes that more organizations need to recognize the urgency for the 3-part aim of reform.

Carol Beasley, Director of Strategic Projects at the Institute for Healthcare Improvement identified three necessary contributors to “change.”  First, organizations of people who have the “will” to create a more efficient health care environment are more effective in achieving that goal and cost-savings.   Secondly, new and innovative ideas must be embraced.  Finally, execution of these ideas is most successful when implemented in an environment which promotes learning between doctors, staff and patients.  Not only alterations to the system, but the means by which measurement of these changes are taken and how often will also be pertinent.  Beasley feels that measuring at six months and one year allow for better correction and longer term success.  She further discussed the example of how Health Partners in Minnesota has developed a comprehensive program for treating patients with diabetes.  The program which is executed with near perfect reliability uses treatment protocols and process measures.  She notes that diabetic patients of Health Partners are seeing results in improved health including a two-thirds reduction in heart attacks, fewer amputations and less loss of eye sight.  Additional information on the results of the Health Partners diabetes program is reported by the website Managed Care in 2009 here.   The health outcomes are examples of how the medical arena is starting to embrace concepts long held in the public health community such as population health, burden of disease, and quality adjusted life years to improve and measure quality in the healthcare they provide.

The Director of the Engelberg Center for Health Care Reform and Chair at the Brookings Institution, Dr. Mark McClellan, agreed with the above speakers and also added comments of his own.  He brought up cost savings options like generic drug substitutions for trade medications used by Medicare Part D.  He also believes that information availability not only for providers and organizations but also for patients will mean better health care. We need to create ways for people to easily identify the cheapest and best health care options for their acute and chronic conditions.  When serving as Director of the Centers for Medicare and Medicaid, (CMS), several physicians explained to Dr. McClellan that they were trying to redesign their practices and clinical services in order to improve the health of the patient population, but ended up practicing medicine in ways which were not incentivized in the Medicare program.  As a result in 2005, CMS created a demonstration project  knows as the Medicare Physician Group Practice, (PGP), Demonstration to allow trials of new payment models to reflect the redesign of the practice and patient care.  The model was the first pay for performance model tried by Medicare care where physician groups were rewarded with a portion of the savings to Medicare derived from the new model of care delivery and organization.  Additional details and outcomes of the demonstration are available from CMS. On August 8, 2011, CMS announced that  all ten original  organizations in the Medicare PGP program are enrolled in a two year extension program.

Sean Cavanaugh, Acting deputy director of Programs and Policy at the Centers for Medicare and Medicaid Innovation, explained the nation’s deficit and budget debate decisions may affect healthcare and the nation’s health as Congress and the president look to Medicare for cost savings.  Mr. Cavanaugh contends fixing the budget through reduced healthcare spending will lead to additional health system problems and poor health outcomes, while redesigning the healthcare system can reduce cost overtime and increase population health status.  While the CMS Center for Innovation has a $10 billion budget, it is important to keep in mind that CMS has an $800 billion budget that they seek to spend wisely.  Programs proven to be effective can be expanded by the Secretary of Health and Human Services.

We look forward to updates on the findings and analysis of the Physician Group Practice demonstration as discussed above and of various demonstration versions of Accountable Care Organizations just getting underway though programs of the Centers for Medicare and Medicaid Innovation .  It’s motivating to see that this country is past the “beginning” of health care reform and strategies are beginning to formulate.

A webcast of the forum can be seen at http://www.kff.org/insurance/trreid_pbs_regional_success.cfm.  U.S. Health Care: The News, the documentary, can be viewed on your local PBS station. Maryland Public Television will air the program on Wednesday February 29, 2012 at 10:00pm and March 1, 2012 2:00 AM.