A recent study(bipartisanpolicy.org) issued by the Bipartisan Policy Center concludes that the U.S. health care system could achieve billions of dollars in savings and improve patient care and satisfaction rates by fundamentally changing the way health care is paid for and delivered in this country.
"We are convinced that reforming our nation's health care system to prioritize quality and value over volume will not only improve health outcomes and the patient experience, but also constrain costs and produce systemwide savings," says the report from the center, a think tank headed by former Senate Majority leaders Tom Daschle, D-S.D., and Bill Frist, R-Tenn.; former Sen. Pete Domenici, R-N.M.; and former Congressional Budget Office Director Alice Rivlin, Ph.D. "Such an outcome would be a real cost benefit to consumers, businesses and taxpayers while helping to reduce our federal deficit."
The authors of the report acknowledge that they don't have estimates for the amount of private sector savings that could be realized by incorporating their suggestions, but they estimate that their recommendations could achieve approximately $560 billion in federal deficit reduction during the next 10 years and significantly more in succeeding years.
- The Bipartisan Policy Center has released a report that makes a strong case for a value-driven health care system, saying that fundamental changes in how the United States pays for and delivers care would result in quality improvements and significant cost savings.
- The report calls for a strengthened primary care workforce, comprehensive medical liability reform, and coordinated and accountable models of health care delivery and payment, among other changes.
- AAFP President Jeff Cain, M.D., says many of the report's recommendations align with the AAFP's efforts to achieve higher quality at a lower cost, but he notes some concerns, as well.
"In the long term, we envision health care that is value-driven and coordinated through organized systems, rather than volume-driven and fragmented," the report states. "These systems will be developed and evolve through a process of innovation and improvement based on collaborative structures of care delivery and payment with accountability, coordination, competition and patient choice."
To achieve this goal, the report makes dozens of recommendations, including a strengthened primary care workforce, comprehensive medical liability reform, and coordinated and accountable models of health care delivery and payment.
"This report contains a lot of good recommendations," says AAFP President Jeff Cain, M.D., of Denver. "The Bipartisan Policy Center is attempting to address some of the very things that the AAFP is most interested in -- better quality of health care at a lower cost."
According to Cain, however, there are areas in the report that could be improved, especially in the area of payment. For example, the report does not recommend higher payments for primary care. "The Academy believes higher payment rates for primary care will create more medical student interest in primary care careers and will strengthen the primary care workforce necessary for better health outcomes and lower health care costs," says Cain.
The report also calls for the replacement of the sustainable growth rate (SGR) formula, but it would tie physician payment updates to the gross domestic product, a proposal opposed by the AAFP. "That is similar to the flaws that are built into the SGR," Cain says.
The report envisions a health care system that uses multidisciplinary teams of doctors, nurses, pharmacists, hospitals, nursing facilities and others working together to ensure patients receive quality care that also incorporates patient values and preferences. "Care is organized around what the patient needs, not around what is expedient for an individual provider," says the report. "Information, such as lab tests, referrals, notes and updated medication lists, is shared seamlessly among health care professionals without the need for patients to intervene."
In this aspirational system, health information technology "facilitates the necessary electronic information sharing across care settings for both clinical decision-making and coordination of care," says the report. "Physicians, nurse practitioners, physician assistants and other health professionals all work to the top of their training in a coordinated manner and are assigned responsibility for improving patients' experiences.
However, says the report, this type of system would be difficult, if not impossible, to achieve "in today's fragmented and poorly coordinated U.S. health care system," and the authors place much of the blame on the prevailing fee-for-service payment system. "Because no one actor in the fee-for-service health care system is directly and consistently responsible for coordinating care, patients are often left to do the job on their own," the report says. "This can be frustrating and inconvenient -- such as when patients themselves need to ensure that routine test results are sent to their physicians -- or even dangerous, if necessary care is missed due to a lack of communication or poor transition planning."
According to the report, Medicare could be the forerunner in establishing new payment policies for the entire health care system, because it provides a critical mass that can change the current payment system. Creating a new option within Medicare that relies on provider networks to deliver and coordinate care would make care more patient-centered and accountable, says the report. "A network could include, for instance, small physician practices, large multispecialty physician groups and hospitals."
Each network would enter into a contract with CMS and would have a unique spending target. "For any given year, if actual spending is below the target and quality goals are met, the network would share in some of the savings," says the report. "Networks that spend more than the target would be required to absorb some of the coverage.
The networks also would be able to design processes to improve care. Care improvements could include innovative care models such as enhanced primary care, patient education and broader care coordination. "Beneficiaries and providers could choose to participate in this new option or remain with the original, fee-for-service component of traditional Medicare," the report says.
However, the authors note that if the coordinated care program improved patients' experiences and health care quality, they would expect that most providers and beneficiaries would choose to participate in the Medicare network rather than the traditional fee-for-service Medicare program.
Medical Liability Reform
The report also identifies medical liability reform as a necessary component of systemwide health care reform. "Our nation's current medical liability system has long been criticized as ineffective, serving both patients and providers poorly," the report says. "Patients deserve care that is safe and effective, and they should be fairly and promptly compensated if they are harmed by negligent or irresponsible care delivery."
However, the report continues, physicians, hospitals and other health care providers should be able to "focus on providing high-quality care without having to worry about negligence claims."
The report suggests that an Institute of Medicine-convened panel of providers, consumers and quality-measurement groups could help determine whether evidence-based quality could be used as a basis for provider defense in medical liability cases. If so, the panel should provide guidance on a process for the adoption of appropriate measures through a quality-certification organization, according to the report.
The Congressional Budget Office, meanwhile, estimates that "enacting a package of common tort reforms would reduce the federal deficit by $54 billion over 10 years," according to the report.