building quality and cost containment into health care reform peter v. lee executive director,...
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Building Quality and Cost Containment Into Health Care Reform
Peter V. LeeExecutive Director, National Health PolicyPacific Business Group on Health
Health Care Reform: The California Perspective Insure the Uninsured – Washington, DC WorkgroupSeptember 3, 2009
1. Promotes better quality.2. Makes it MORE likely that patients
“ALWAYS AND ONLY” get the right care, at the right time from the right clinician in the right setting – especially for those who need care the most
3. Promotes more affordable care and slows the growth of health care costs
4. Fosters coordination of care5. Improves accountability of clinicians
and all providers6. Fosters innovation
Scorecard for ALL Policy Options
2© Pacific Business Group on Health, 2009
Health Reform – Key Employer Issues
Defining “Shared Responsibility”
New Rules, Exchanges, Connectors & the Public Plan
Minimum Benefits
Delivery System Reform
3© Pacific Business Group on Health, 2009
Health Reform Elements
Shared Responsibility Financing – Limits on Tax Exclusion? Individual Mandate
Level/type of subsidy Employer Mandate
All employers or cut off at “very small” If “pay or play” – what’s the “pay”
What would make employer mandate “palatable” For some:
Nothing For others:
Reasonable definition of “pay” and “play” Clear path to cost reduction System change Permeability – require, allow, prohibit
For others: Get employers out entirely (Wyden/Bennett; CED)
4© Pacific Business Group on Health, 2009
Health Reform Elements
New Rules, Coverage Expansion & Connector/Exchange New Insurance Rules
Guaranteed Issue No Pre-existing conditions Rating Rules
Exchange – who’s in/out Permeability – require, allow, prohibit Which plans
Subsidies for individuals/businesses “Public plan” options
Price Setting Required inclusion of providers
Cooperative Option
Minimum Benefits Minimum, standard benefit package Level of actuarial equivalence (65%?) Specified in statue or delegated to outside entity Value based insurance design
5© Pacific Business Group on Health, 2009
Health Reform Elements
Delivery and System Reforms Quality improvement
Provider-Level Measurement Public Reporting (transparency) Comparative Effectiveness Research (AND use)
Chronic care management Wellness/Prevention Patient Engagement & Shared Decision-making Payment reform: moving from volume to value
Alignment between public and private programs Promote primary care, collaboration/integration and
paying for “Value” Medical home Accountable care organizations Episodes, bundles
Health Information Technology Workforce Medical malpractice reform
6© Pacific Business Group on Health, 2009
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Big Issues: Public & Private Alignment
Need alignment to avoid the cost-shift train wreck:The “[F]ederal health spending trends should not be viewed in isolation from the health care system as a whole.... Rather, in order to address the long-term fiscal challenge, it will be necessary to find approaches that deal with health care cost growth in the overall health care system.” Peter Orszag, quoting David Walker, Comptroller of GAO
• Use the same measures
• Address cost-shifting from public to private
• If “public plan”…do it to promote value
© Pacific Business Group on Health, 2009
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Big Issues: Bending the Curve with Confidence
Need to “score” for Congress (federal spending) AND for the nation (national health expenditures):“We do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount.” Doug Elmendorf, Director CBO
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All Other Health Care
Medicaid
Medicare
© Pacific Business Group on Health, 2009
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www.pbgh.org — an overview of PBGH programs and initiatives
www.healthcaredisclosure.org — Consumer Purchaser Disclosure Project, good source for background and resources on the value agenda
www.centerforpaymentreform.org – Leadership effort to reform payment to foster value
www.standforquality.org – Coalition promoting the measurement of performance as the foundation for reform
Contact: Peter Lee at [email protected]
To subscribe to the PBGH E-Letter, go to www.pbgh.org/news/eletters
To Learn More and Additional Resources
© Pacific Business Group on Health, 2009