Darren McCollester/Getty Images

The Center for Health Policy Director Len M. Nichols was quoted this morning on NPR’s Morning Edition. To read and listen the the full story click the link.

President Embraces ‘Obamacare’; What Would Romney Do?

Click the link for an interactive PDF version of the Newsletter

This newsletter will be published monthly as an update of what the Center for Health Policy Research and Ethics is working on.

Please click  CHPRE Newsletter August to view our interactive news letter!

New York Times reporters Reed Ableson and Katie Thomas published their story “Sense of Peril for Health Law Gives Insurers Pause” in which they interviewed several individuals on either side of the controversy.

David Lightman and Michael Doyle outlined potential outcomes in their article “Much Could Change with Supreme Court Decision on Health Care Law”.

Stay tuned for further quoted articles referencing Dr. Nichols.

Grand Junction, Colorado, is one of the lowest-cost, highest-quality health care systems in the country. A community of about 120,000 people on the western slope of the Rocky Mountains, its health care performance is on par with widely-admired high-performance integrated delivery systems like Mayo Clinic, Geisinger, Kaiser Permanente, the Billings Clinic, Denver Health, and Virginia Mason. Grand Junction does not have an integrated system; most of its health care payers and providers are unaffiliated, just like the majority of the country. Yet, this Colorado community boasts consistently excellent patient outcomes at relatively low cost. As policymakers develop national proposals to improve the quality, efficiency, and sustainability of our nation’s health system, it is instructive to study Grand Junction’s achievements.

As is true of the majority of markets in the country, Grand Junction has no formally integrated system; most of its healthcare payers and providers are unaffiliated with one another. Yet, Grand Junction engages in a community-wide effort that is far ahead of the curve in implementing a state-of-the-art health information technology network, which enhances care coordination and limits duplication. The community also boasts a high-functioning safety net system that works well with local doctors and hospitals and employs the latest innovations in primary, preventive, and palliative care.

Some news reports suggest that Grand Junction’s healthcare performance may be a geographic and historical anomaly, a product of charismatic leadership in a particular time and place that cannot easily be replicated.1 Questions have been raised about whether Grand Junction’s high-quality health system can be sustained because it is subject to the same forces that have pushed the nation’s health system to focus on maximizing revenue rather than delivering high-quality, patient-centered care.2 Some features of Grand Junction’s medical community may be unique. But it is also true that Grand Junction demonstrates that with a vision of mutual self-interest any community in the country can create and maintain a high-performance health system.

Grand Junction succeeds because of a deep sense of community, strengthened by data sharing and aligned incentives. The close-knit relationships among the lead actors and institutions can be characterized by their shared commitment to provide efficient, high-quality, and patient-centered care to all residents of Mesa County. Over the years, this has been made possible through aligned financial incentives to encourage the medical culture to focus on the needs of the greater community—and thrive. This commitment has led Grand Junction to become exceptionally cooperative by U.S. health system standards.

This paper aims to explain how this spirit of cooperation, aligned financial incentives, and overriding sense of common purpose combine to lower costs and improve outcomes. We hope that the example of Grand Junction can inspire other communities, including those that do not presently have an integrated delivery system, to discern and implement their own path to achieving far better performance, far more quickly than many voices in the national health reform debate now assume.

“Grand Junction Colorado: A Health Community that Works,” New American Foundation (August 2009)

Click here to view the article.

Our nation has an obligation to make sure everyone has quality, affordable health coverage. However, coverage will not be sustainable unless we refocus our delivery system on patients, improve quality, and increase efficiency.

Transforming our delivery system is good public policy and a necessary component of fiscal responsibility. Yet, we will not slow the rate of health care cost growth until we create stronger incentives for providers – the people who deliver care – to focus on quality and efficiency.

Please join the New America Foundation Health Policy Program and Health CEOs for Health Reform (HC4HR) as we discuss transformative, patient-centered reforms. HC4HR leaders will explain how bold incentives can make health care affordable and how their own experience proves a sustainable, value-based system is achievable.

“Realigning U.S. Health Care Incentives to Better Serve Patients and Taxpayers, “(with Health CEOs for Health Reform) New America Foundation (June 2009)

Click here to view the article.

Many comprehensive reform proposals reflect the fundamental need to control health care costs and create a marketplace wherein insurers compete on value and customer satisfaction, rather than risk selection and marketing. Several leading proposals promote competition between private health plans and a “public” health insurance option. Unfortunately, the debate over this issue has become polarized unnecessarily. It is possible to structure a new insurance marketplace so that public and private health plans compete on a level playing field. This will require separating the oversight of the public plan from that of the managers of the marketplace or exchange(s). It will also require that all rules of the marketplace – benefit package requirements, insurance regulations, and risk adjustment processes – apply to all plans equally, whether public or private. Finally, this model requires that we address cost growth containment systemically and avoid relying heavily on the public plan’s potential market power. In turn, this will require a commitment on the part of policymakers to acquire a health information infrastructure, develop best practice information, and encourage re-aligned incentives that promote high-quality, efficient care for all.

“A Modest Proposal for a Competing Public Health Plan,” (with John Bertko). New America Foundation (March 2009)

Click here to view the article.

The ever-growing cost of health care is the largest threat to our nation’s long-term fiscal future. One way of tackling this problem is by using Medicare-the nation’s largest purchaser of health care-as a catalyst for widespread efficiencies in the private sector. Medicare must become a more value-based purchaser to make the Program sustainable over time and incent the private sector toward change. It is imperative that we act decisively and soon. Yet, we believe embarking on a Medicare-only reform effort would be far less productive than comprehensive delivery system reform. Medicare buys health care from the broader delivery system. Therefore, if we fail to address our system as a whole, we will have failed to solve the Medicare Program’s underlying problems. Delivery system reform must benefit all payers, patients, and providers who are willing to excel, but Medicare can and should lead the way.

Edited with Robert A. Berenson, MD. New America Foundation, March 2009. Co-authored essay within that volume with Robert A. Berenson and Thomas Emswiler, “Reforming Medicare’s Governance to Enhance Value-Based Purchasing.”

Click here to view the article.