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Healthcare reform from the inside out
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Drew Altman, CEO of the Kaiser Family Foundation, writes in his new column that containing costs will require significant reform involving those that deliver healthcare, while the bills now in Congress focus on the payers of healthcare. (http://www.kff.org/pullingittogether/102909_altman.cfm)
"The Systems Reformers believe that the best way to bend the cost curve is not through external market incentives or regulatory controls, but from the inside out, by creating a smarter health care system with the information base, new delivery models and payment incentives that will improve quality and lower costs. In truth, the Systems Reformers have lived among us all along, but until recently their research and ideas were more focused on improving quality than controlling costs and were featured mainly in respected journals and conferences. They seldom made it into the lexicon or armamentarium of policymakers or the spotlight of journalists.
"The Systems Reformers' paradigm is reflected in the "bending the curve" elements of the health reform legislation currently in Congress, which mostly come in the form of pilot projects and experiments. These include tests of ideas like Accountable Care Organizations, "pay for performance" and "bundled payments," as well as efforts to create a smarter, evidence-based health delivery system through comparative effectiveness research. But not all Systems Reformers' ideas are embodied in the health reform bills in Congress. Numerous experiments are underway across the health care delivery system and in both the private and public sectors and touted by a broad range of health care leaders.
"It is a note of caution that when it came to producing hard cash to pay for health reform legislation, the Congress—driven in large part by the Congressional Budget Office's estimates—did not put many of its eggs in the payment and delivery reform basket. To produce a scoreable, deficit-neutral bill, they resorted to a mix of tried and true reductions in Medicare payments and new revenue raisers, plus added a Medicare Commission modeled loosely on the military base closure commission."
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