Former CMS Administrator Mark McClellan, M.D., Ph.D., considers the recently passed Patient Protection and Affordable Care Act an opportunity for family physicians to play a major role in implementing health care reform on the state level. McClellan gave the keynote address at the 2010 AAFP State Legislative Conference here on Nov. 13.
Former CMS Administrator Mark McClellan, M.D., Ph.D., tells attendees at the 2010 AAFP State Legislative Conference that there are opportunities to "make care better and to do it in a way that really reflects primary care and family practice leadership."
"There are some opportunities that we have not had before to make care better and to do it in a way that really reflects primary care and family practice leadership," said McClellan, director of the Engelberg Center for Health Care Reform and the Leonard D. Schaeffer director's chair in health policy studies at the Brookings Institution in Washington. "But it is by no means automatic, and it is going to take some very important steps."
The Patient Protection and Affordable Care Act gives states wide latitude in implementing various provisions of the health care reform law. It provides funding for states to enact the law, and much of the funding is open-ended. This will give states the flexibility to put in place health insurance exchanges and other provisions of the act in their own way, said McClellan, who served as CMS administrator from 2004-06 and as FDA commissioner from 2002-04.
One of the underlying goals of health care reform is to simultaneously improve health care quality while saving costs, a goal that will require changes in the way health care is delivered, according to McClellan. The Affordable Care Act will provide opportunities to test models of care that will improve care and save money.
"The challenge is how to make that work over the next several years," McClellan said. "But we don't have much time -- especially given historical standards for how long it takes Medicare to do a demonstration program and make it work."
McClellan called for leadership from family physicians and other health care professionals in implementing policies in the health care reform law.
McClellan identified four key elements of health care reform, including better measurements, payment reform, benefit reform and evidence.
"With better measurements, you can take steps to implement payment reform," McClellan said. And with better evidence, it is possible to gauge whether health care reforms actually work. "Every single payment reform I am involved with now ... (has) measurements and prerequisites," he noted.
McClellan urged conference participants to think of accountable care organizations, or ACOs, and other proposed models of care as ways of moving from the current fee-for-service system to payments that are aligned with improving care and reducing costs.
"Don't think of these steps in isolation," he said. "There are a lot of steps that are available now to support moving in this direction if you view them comprehensively."
For example, medical homes can provide support and preliminary funding for improving care coordination, one of the tenets of ACOs. McClellan pointed to the Multi-Payer Advanced Primary Care Practice Demonstration recently launched by CMS as an example of demonstration projects that can provide upfront seed money to promote care coordination.
That demonstration involves Medicare, Medicaid and private insurance plans in eight states to evaluate the effectiveness of physicians and other health care professionals working in a more integrated fashion across the system and receiving more coordinated payment from public and private health plans. It is expected to eventually include as many as 1,200 medical homes and to serve as many as 1 million Medicare beneficiaries, according to CMS.
During his address, McClellan invited members of the audience to ask questions, leading to some give-and-take between McClellan and conference attendees. Taejoon Ahn, M.D., M.P.H., of Walnut Creek, Calif., asked about the future of health care reform in the next Congress when Republicans will be in control of the House.
McClellan said Republicans would not be able to repeal or defund the law, but they could modify how it is implemented. He also predicted "nothing major is going to get solved at the federal level" in terms of health care reform during the next two years.
Texas AFP EVP Tom Banning asked whether Congress would find a long-term solution to the sustainable growth rate formula, which has called for steep reductions in Medicare physician payment rates during the past eight years.
"It is going to be very difficult to do a long-term fix," McClellan answered. He said Congress is likely to rely on short-term payment patches to block impending reductions.
"In the short term, there will continue to be six-month, one-year, one-month fixes for a while longer until we figure out a more competent way to reform our whole payment system," McClellan said.