Health care costs continue to spiral upward. Partisan politics continue to swirl. And, caught in the vortex, American patients continue to see their first-dollar health care coverage siphon away.
AAFP Environmental Scan
Consumer-Driven Health Care To Be Hallmark of 2006
By News Staff
12/16/2005
New health care policy took a beating in 2005 as lawmakers scrambled to staunch the flow of red ink in the federal budget and state Medicaid budgets, according to GMMB, a Washington-based political and public affairs consulting firm. Distracted by public perceptions of the war in Iraq, high fuel prices and federal investigations of political leaders, Congress and the Bush administration have focused less on health care and more on shoring up support within their constituencies, said GMMB in the 2005 Environmental Scan presented to the AAFP Board of Directors at its December meeting.
Meanwhile, employers have scrambled to maintain a healthy bottom line by asking their workers to pay more health insurance premiums and higher copayments and deductibles. The cost shift has sharpened workers’ awareness of health care costs, honed their skills as health care consumers and recast their perceptions of health care, say analysts at GMMB. For growing numbers of patients, health care is a commodity to be purchased, and hospitals, physicians and other health care professionals have become contractors hired to perform a service, according to the analysts.
The trend toward consumer-driven health care will grow, and, as in any market, the consumer is king. And the king demands lower cost, more convenience and better quality, said the GMMB report, which cited an August 2005 Kaiser Family Foundation Health Poll Report Survey. (PDF file: 52 pages / 191 KB. More about PDFs.) The survey found that lowering the cost of health insurance and prescription drugs ranked most important among 40 percent of respondents. Moreover, 25 percent of respondents in a November Gallup News Services poll said the “most urgent” health problem was the cost of health care and health insurance.
That means physicians will face pressure from patients, insurance companies, and Medicare and Medicaid to meet quality standards designed to reduce the cost of health care, rein in patients’ out-of-pocket expenses, and provide convenience and easy access to services, according to the Environmental Scan.
Witness the growth of pay-for-performance initiatives in the private and public sectors and the explosion of retail health clinics in pharmacies across the nation. The U.S. Senate has passed the Wired for Health Care Quality Act, S. 1418, (at the THOMAS Web site, select "Bill Number" and type "S 1418" in the search field), which, in addition to providing funding for physicians to buy or upgrade electronic health records, requires development of health quality measures that will be the foundation for P4P under Medicare.
In the U.S. House, lawmakers are working to pass the 21st Century Health Information Act, H.R. 2234, (at the THOMAS Web site, select "Bill Number" and type "HR 2234" in the search field), which would provide funding for implementing electronic health records and make payment adjustments for physicians who use an approved information technology network.
Other measures that have been introduced include the Medicare Value Purchasing Act, S. 1356, (at the THOMAS Web site, select "Bill Number" and type "S 1356" in the search field), now in the Senate Committee on Finance, and the Medicare Value-Based Purchasing for Physicians' Service Act, H.R. 3617, (at the THOMAS Web site, type "HR 3617"), which has been referred to both the House Energy and Commerce Health Subcommittee and the House Ways and Means Committee.
Meanwhile, CMS has released the Physician Voluntary Reporting Program, considered by many to be a "warm-up" to P4P, and launched pilot programs to test value-based purchasing in 10 markets.
In addition, retail health clinics have exploded. In 2004, these clinics were pilot projects in Minneapolis-St. Paul and Baltimore. Today, 89 clinics operate in retail pharmacies in several areas of the country, and the companies behind the clinics have announced plans to open hundreds more -- including 1,300 Take Care Clinics in Eckerd pharmacies and Albertson's grocery stores and up to 3,500 Wal-Mart stores -- by the end of 2007.
An October survey by Public Opinion Strategies shows that patients like the retail clinic concept. Fifty-nine percent said they would be likely to use such a service, and nearly half said they were “very likely” to go to a retail health clinic. Why? No appointments, short waits, less expense, better hours and closeness to home, said survey respondents.
Meanwhile, employers have scrambled to maintain a healthy bottom line by asking their workers to pay more health insurance premiums and higher copayments and deductibles. The cost shift has sharpened workers’ awareness of health care costs, honed their skills as health care consumers and recast their perceptions of health care, say analysts at GMMB. For growing numbers of patients, health care is a commodity to be purchased, and hospitals, physicians and other health care professionals have become contractors hired to perform a service, according to the analysts.
The trend toward consumer-driven health care will grow, and, as in any market, the consumer is king. And the king demands lower cost, more convenience and better quality, said the GMMB report, which cited an August 2005 Kaiser Family Foundation Health Poll Report Survey. (PDF file: 52 pages / 191 KB. More about PDFs.) The survey found that lowering the cost of health insurance and prescription drugs ranked most important among 40 percent of respondents. Moreover, 25 percent of respondents in a November Gallup News Services poll said the “most urgent” health problem was the cost of health care and health insurance.
That means physicians will face pressure from patients, insurance companies, and Medicare and Medicaid to meet quality standards designed to reduce the cost of health care, rein in patients’ out-of-pocket expenses, and provide convenience and easy access to services, according to the Environmental Scan.
Witness the growth of pay-for-performance initiatives in the private and public sectors and the explosion of retail health clinics in pharmacies across the nation. The U.S. Senate has passed the Wired for Health Care Quality Act, S. 1418, (at the THOMAS Web site, select "Bill Number" and type "S 1418" in the search field), which, in addition to providing funding for physicians to buy or upgrade electronic health records, requires development of health quality measures that will be the foundation for P4P under Medicare.
In the U.S. House, lawmakers are working to pass the 21st Century Health Information Act, H.R. 2234, (at the THOMAS Web site, select "Bill Number" and type "HR 2234" in the search field), which would provide funding for implementing electronic health records and make payment adjustments for physicians who use an approved information technology network.
Other measures that have been introduced include the Medicare Value Purchasing Act, S. 1356, (at the THOMAS Web site, select "Bill Number" and type "S 1356" in the search field), now in the Senate Committee on Finance, and the Medicare Value-Based Purchasing for Physicians' Service Act, H.R. 3617, (at the THOMAS Web site, type "HR 3617"), which has been referred to both the House Energy and Commerce Health Subcommittee and the House Ways and Means Committee.
Meanwhile, CMS has released the Physician Voluntary Reporting Program, considered by many to be a "warm-up" to P4P, and launched pilot programs to test value-based purchasing in 10 markets.
In addition, retail health clinics have exploded. In 2004, these clinics were pilot projects in Minneapolis-St. Paul and Baltimore. Today, 89 clinics operate in retail pharmacies in several areas of the country, and the companies behind the clinics have announced plans to open hundreds more -- including 1,300 Take Care Clinics in Eckerd pharmacies and Albertson's grocery stores and up to 3,500 Wal-Mart stores -- by the end of 2007.
An October survey by Public Opinion Strategies shows that patients like the retail clinic concept. Fifty-nine percent said they would be likely to use such a service, and nearly half said they were “very likely” to go to a retail health clinic. Why? No appointments, short waits, less expense, better hours and closeness to home, said survey respondents.
