Brookings Institute: Bending the Curve (Real Health Care reform )

[SnyderShrugged]

I found this study after searching for refoms that could actually aid our union in fixing the actual problem: costs

http://www.brookings.edu/~/media/Files/rc/reports/2009/0826_btc/0826_btc_execsummary.pdf

The summary of thoughts:

This strategy consists of four interrelated pillars:

Invest in better information and tools, such as health information technology, as a foundation to guide and support a reformed system. Critical to these investments’ success is ensuring providers and insurers have the flexibility

and incentives to use these tools effectively — for example, liability protections for following best practices identified by comparative effectiveness research. But reform cannot stop here: These investments are a necessary foundation for cost containment that will be ineffective if implemented alone.

Transition to accountable payment systems that reward providers for delivering lower-cost, high-quality care. Adjustments in Medicare and Medicaid fee-for-service payments can yield short-term savings. However, fundamental reform requires transitioning to accountable payments in these public programs, reinforced by budget pressures to make fee-for-service less attractive over time. Critical to reform’s success is greater institutional flexibility and ability to learn from experience, including an independent entity with authority to ensure that steps to improve Medicare and Medicaid

sustainability are addressed by Congress.

Restructure non-group and small-group health insurance markets and coverage subsidies based on an exchange model that pools risk outside of employment and promotes competition on cost and quality. To bend the curve in the employer-provided insurance market, the tax exclusion must be scaled back to foster the design and purchase of more cost-effective benefits. New affordable coverage subsidies should be structured so that beneficiaries pay the incremental cost for richer insurance benefits. Finally, Medicare Advantage benchmarks should be reduced through competitive bidding, with quality bonuses.

Support and encourage better individual choices to enhance the patient role in improving health and lowering health care costs. Medicare’s benefit design should feature value-based tiered copays and protect against high out-of-pocket costs, while limiting first-dollar supplemental

coverage. Reforms should support premium rebates for measurable health improvements. Also, prevention investments

should broadly pilot and evaluate measurable strategies for helping individuals to lose weight and reverse the obesity trend.

Slowing health care cost growth, while sustaining and improving

quality, will not be easy but is doable.

Successful implementation of our recommendations to achieve a meaningful slowdown in spending growth will require:

• Improvements in the incentives of all health care stakeholders, with increasing effects over time;

• Enough flexibility to continually evaluate and modify reforms, building on successes and learning from mistakes; and

• Clarity of vision about achieving a health care system that consistently achieves better quality while saving money, with steady, interdependent and reinforcing steps to get there.

We believe the reform strategy presented here offers the most promise for bending the cost curve and producing the high-value health care system our nation urgently needs.

[SnyderShrugged]

I cant tell you all how much I appreciated reading an actual set of reform proposals that are intended to reduce costs and have long term benefit.

I liked the fact that politics did not appear in their analysis too.

It's about time that the issues are looked at outside of the beltway lens for a change.

[SnyderShrugged]

dang, it looks like it will get as much attention here as it will in congress! LOL

[MurrayH81]

Largely, the people have abdicated their responsibility to provide guidance to their political representation and provide for improvement through meaningful, fact-based discussion.

The distractions of modern entertainment and the need for people to work harder than ever to make ends meet insures that those in control of our government will continue to drive this country below 3rd world status.

Our "bought and paid for" Press will not cover and insist on framing the debate in these terms.

Thanks for posting the interesting article though. It is good stuff.

[SnyderShrugged]

Largely, the people have abdicated their responsibility to provide guidance to their political representation and provide for improvement through meaningful, fact-based discussion.

The distractions of modern entertainment and the need for people to work harder than ever to make ends meet insures that those in control of our government will continue to drive this country below 3rd world status.

Our "bought and paid for" Press will not cover and insist on framing the debate in these terms.

Thanks for posting the interesting article though. It is good stuff.

My pleasure!

[SnyderShrugged]

This one "pillar" really got me thinking.

Transition to accountable payment systems that reward providers for delivering lower-cost, high-quality care. Adjustments in Medicare and Medicaid fee-for-service payments can yield short-term savings. However, fundamental reform requires transitioning to accountable payments in these public programs, reinforced by budget pressures to make fee-for-service less attractive over time. Critical to reform’s success is greater institutional flexibility and ability to learn from experience, including an independent entity with authority to ensure that steps to improve Medicare and Medicaid

sustainability are addressed by Congress

The idea of rewarding providers who work at keeping costs low and quality high is an incredibly great thought!

I could imaging a system of incentives like this, and I think it would be greatly received from providers, insurers, and the insured.

[alexey]

This one "pillar" really got me thinking.

Transition to accountable payment systems that reward providers for delivering lower-cost, high-quality care. Adjustments in Medicare and Medicaid fee-for-service payments can yield short-term savings. However, fundamental reform requires transitioning to accountable payments in these public programs, reinforced by budget pressures to make fee-for-service less attractive over time. Critical to reform’s success is greater institutional flexibility and ability to learn from experience, including an independent entity with authority to ensure that steps to improve Medicare and Medicaid

sustainability are addressed by Congress

The idea of rewarding providers who work at keeping costs low and quality high is an incredibly great thought!

I could imaging a system of incentives like this, and I think it would be greatly received from providers, insurers, and the insured.

I was under the impression that this is a part of ObamaCare that's commonly referred to as "rationing" and "government bureaucrats making health care choices for you".

[AsburySkinsFan]

Cutting costs is only one leg of reform. Making the health care available to more people while maintaining quality of care in my mind has to be the primary. We can talk about cutting costs all day long, but who are going to be the beneficiaries of the cost cuts? Insurance companies, health care institutions or the patients? You can go ahead and pick two of those three.

[PeterMP]

Cutting costs is only one leg of reform. Making the health care available to more people while maintaining quality of care in my mind has to be the primary. We can talk about cutting costs all day long, but who are going to be the beneficiaries of the cost cuts? Insurance companies, health care institutions or the patients? You can go ahead and pick two of those three.

You can't extend care to everybody w/o cutting costs. We aren't really paying for the care people are getting now.

Doing it in a manner that doesn't return the money to insurance companies and/or health care institutions is the issue (noting you really haven't controlled costs if you haven't reduced what a person is actually paying)l.

[SnyderShrugged]

I was under the impression that this is a part of ObamaCare that's commonly referred to as "rationing" and "government bureaucrats making health care choices for you".

I'm not sure how "transferring to an accountable payment system that rewards providers for delivering lower cost/higher quality care" is rationing?

Could you expand on it some please?

[Baculus]

I couldn't read the .PDF for some reason, but the snippet you posted sounds interesting as one way to institute some reform.

[AsburySkinsFan]

You can't extend care to everybody w/o cutting costs.

The question is who gets their costs cut? And since these are probably publicly traded companies where the Board has a fiduciary responsibility to their shareholders where they are legally obligated to make as much profit as possible I'm fairly certain that these companies aren't going to be lining up to be the one's who take the hit.

[alexey]

I'm not sure how "transferring to an accountable payment system that rewards providers for delivering lower cost/higher quality care" is rationing?

Could you expand on it some please?

It's not, just like requirements to reimburse end-of-life counseling would not establish death panels.

I believe the underlying argument for "rationing" and "govt interference" goes something like this: having any kind of a system that does comparative effectiveness would eventually lead to that system playing a role in treatment decisions being made by you and your doctor. For example, such a system would probably discourage expensive treatments that are known to be ineffective. This is actually one of the more reasonable arguments, but unfortunately it fails to account for reality.

[SnyderShrugged]

It's not, just like requirements to reimburse end-of-life counseling would not establish death panels.

I believe the underlying argument for "rationing" and "govt interference" goes something like this: having any kind of a system that does comparative effectiveness would eventually lead to that system playing a role in treatment decisions being made by you and your doctor.

I'm still very confused why you would bring up anything about rationing or the debate on the so called "death panels" in this thread?

Nothing has been mentioned along those lines at all?

[SnyderShrugged]

The question is who gets their costs cut? And since these are probably publicly traded companies where the Board has a fiduciary responsibility to their shareholders where they are legally obligated to make as much profit as possible I'm fairly certain that these companies aren't going to be lining up to be the one's who take the hit.

Most major companies, especially in the health insurance industry are extremely active in cost cutting efforts. These efforts are driven by customer voice and critical to quality characteristics provided by the end state customers.

Everyone benefits from cost cutting that is done this way, especially those that pay the premiums.

[SnyderShrugged]

I couldn't read the .PDF for some reason, but the snippet you posted sounds interesting as one way to institute some reform.

Oh sorry about that!

You didnt miss much else anyway, the 4 pillars were really the core of the doc. I'll try to post the link to the pdf though just in case.

[alexey]

I'm still very confused why you would bring up anything about rationing or the debate on the so called "death panels" in this thread?

Nothing has been mentioned along those lines at all?

Obama has been talking about the need to do comparative effectiveness studies and deal with the fee-for-service approach for a while now... I was surprised to see you have a eureka moment about it, and I wanted to point out that this is one of several central reform issues that get demonized.

This is probably the second most demonized idea (public option being the leading issue by far).

[SnyderShrugged]

Obama has been talking about the need to do comparative effectiveness studies and deal with the fee-for-service approach for a while now... I was surprised to see you have a eureka moment about it, and I wanted to point out that this is one of several central issues that get demonized.

It wasnt a eureka moment at all, I'd be very interested to see where anyone in congress or the president has mentioned rewarding providers who keep costs low and quality high. This is untouched ground.

Sure the fee for service issue has been mentioned, but what appears to differ with this reccomendation is that transitioning to accountable payments in these public programs will reinforce budget pressures to make fee-for-service less attractive over time.

As far as i can tell, all the current proposals are a short term addressing of fee for service, that would possibly create short term savings.

this study suggests a long term approach.

(I may be off, and I apologize if I am, but you seem to be wanting to drive this into the same old debate points that have been in thread after thread here. I'm seeking to expand the debate well beyond politics and into practicality and reality, politics aside. Again, I am sorry if I am misreading your intentions)

[alexey]

It wasnt a eureka moment at all, I'd be very interested to see where anyone in congress or the president has mentioned rewarding providers who keep costs low and quality high. This is untouched ground.

Sure the fee for service issue has been mentioned, but what appears to differ with this reccomendation is that transitioning to accountable payments in these public programs will reinforce budget pressures to make fee-for-service less attractive over time.

As far as i can tell, all the current proposals are a short term addressing of fee for service, that would possibly create short term savings.

this study suggests a long term approach.

(I may be off, and I apologize if I am, but you seem to be wanting to drive this into the same old debate points that have been in thread after thread here. I'm seeking to expand the debate well beyond politics and into practicality and reality, politics aside. Again, I am sorry if I am misreading your intentions)

I heard them say put out several ideas about that... The one that frequently comes up is to reduce payments for preventable readmission to hospitals. There was also talk about avoiding repeat and/or unnecessary tests by improving information exchange.

Here is a "highly detailed" plan from WH website:

http://www.whitehouse.gov/issues/health_care/plan/

Implements a number of delivery system reforms that begin to rein in health care costs and align incentives for hospitals, physicians, and others to improve quality. The President’s plan includes proposals that will improve the way care is delivered to emphasize quality over quantity, including: incentives for hospitals to prevent avoidable readmissions, pilots for new "bundled" payments in Medicare, and support for new models of delivering care through medical homes and accountable care organizations that focus on a coordinated approach to care and outcomes.

I certainly do not want to rehash old debate points, if things we hear from the right can be called that... I suppose a part of me wanted to gloat a bit because I'm a little bitter about the politics of this. I wish more people would try to engage in discussion of policy, a meaningful debate about what is the desired result and whether current proposals would achieve that.

[SnyderShrugged]

I certainly do not want to rehash old debate points, if things we hear from the right can be called that... I suppose a part of me wanted to gloat a bit because I'm a little bitter about the politics of this. I wish more people would try to engage in discussion of policy, a meaningful debate about what is the desired result and whether current proposals would achieve that.

We see eye to eye!

[AsburySkinsFan]

Most major companies, especially in the health insurance industry are extremely active in cost cutting efforts. These efforts are driven by customer voice and critical to quality characteristics provided by the end state customers.

Everyone benefits from cost cutting that is done this way, especially those that pay the premiums.

Sorry but I don't buy it. Companies all over the place are reducing their costs by cutting the products they sell to the consumer, yet maintaining the same rates for those products, why am I supposed to think that the insurance companies are all of the sudden going to break this trend? Their job is to make profit for their shareholders, they cut costs to pass the savings to the shareholders NOT to the consumers.

[SnyderShrugged]

Sorry but I don't buy it. Companies all over the place are reducing their costs by cutting the products they sell to the consumer, yet maintaining the same rates for those products, why am I supposed to think that the insurance companies are all of the sudden going to break this trend? Their job is to make profit for their shareholders, they cut costs to pass the savings to the shareholders NOT to the consumers.

whether you "buy it" or not is of no bearing. fact is, virtually every major helath insurer (as well as every major company in general) has a quality program in place that is based on philosophies of deming, juran, etc. ALL of which are driven by consumer critical to quality characteristics.

I know this because I teach and certify people in that exact methodoilogy and in a major insurance company.

Yes, they need to make profit for the shareholders, yet that profit does not come at the expense of the consumer, especially in terms of quality and efficiency.

Most major health insurers also contract with the government, nearly all of those bids have a mandatory requirement for a robust quality programs like those i have just mentioned.

[Baculus]

Oh sorry about that!

You didnt miss much else anyway, the 4 pillars were really the core of the doc. I'll try to post the link to the pdf though just in case.

Thanks!

Ar these four points related to, say, the health insurance used by Walmart that rewards better or improved health through incentives?

[SnyderShrugged]

Thanks!

Glad yopu reminded me! I almost forgot!

here is the page where I downloaded the pdf from.

http://www.brookings.edu/reports/2009/0901_btc.aspx

[AsburySkinsFan]

whether you "buy it" or not is of no bearing. fact is, virtually every major helath insurer (as well as every major company in general) has a quality program in place that is based on philosophies of deming, juran, etc. ALL of which are driven by consumer critical to quality characteristics.

So you're telling me that these companies are going to voluntarily cut their costs and pass those savings on to the customers rather than to their shareholders? Sorry, but Jiff peanut butter is giving me 1oz less spread by carving out the bottom of the jar and charging me the same price they did before, why should I trust these businesses to do what is in my interest? Am I to assume that the insurance companies and health care providers truly aren't going to take an ounce away and charge me the same?