The Users' Guide to the Health Reform Galaxy

Bringing home the costs of doing nothing

Bowen Garrett, a senior research associate at the Urban Institute, writes about new research about the consequences of doing nothing on health reform.

The health reform proposals currently under heated debate, by the very nature of the problems they are tackling, are complex and contain many moving parts.  This complexity makes it difficult for people to envision what their health insurance and health care will look like under reform.  It is natural for those who have good coverage now to prefer their current situation, which they know, to an uncertain world under health care reform.  Being shielded from the full costs of the health care they receive, people who now have coverage from their employers can be comfortably numb to the sting of rapidly increasing health care costs that we all face.  The problem is, the status quo is not lying still.  It is moving—in a very bad direction.

Earlier this year, my colleagues and I at the Urban Institute put out a report about the economic implications for the nation if health reform legislation does not happen this year.  Based on economic trends and health care cost growth and other factors, we predicted that large numbers of people who have private health insurance coverage now would lose it over the next 10 years.  Middle-class families would be hit the hardest.  Health care costs paid by employers, and federal and state governments, would rise dramatically.  Individuals and families would be forced to pay more in taxes, face slower wage growth, and bear even higher out-of-pocket health care costs than they do now. 

Our findings for the nation as a whole were striking and sobering, but they become even more relevant to us when they get closer to home.  So today, with the Robert Wood Johnson Foundation, we’re releasing a report that estimates what would happen state-by-state, and in the District of Columbia, if health reform fails.   

Atonement and reflection

A while back, I was thinking of posting an apology on this blog, because even though I promised that this blog would step back from the Health Reform 2009 scrum and try and make sense of health reform doings for you all, we began getting such a volume of content from so many esteemed experts and leaders, I started posting things like a madwoman.  I just couldn't justify holding on to any of our recent pieces, they were either too timely or too good or both. 

Then last week, our blog pipeline got a bit dry (don't worry: that's not going to last for very long), posting was light, and I heard nary a peep from our many blog contributors.  I think that's because we're all waiting for that giant shoe to drop, and kibbitzing in the interim was starting to feel a bit beside the point.

Some people can do it (kibbitzing) very well, though.  If you've been following the health reform debate all year, like I have, there are certain expert voices that emerge, out of the babble, as more distinctive and interesting than others.  Last week, I listened to this roundtable on health reform sponsored by NEJM, featuring Dr. Atul Gawande of the New Yorker magazine and Elliott Fisher of the Dartmouth Atlas, and I was particularly interested in what the economist Jonathan Gruber had to say, to the point where I looked up his other opinions.  (Anyone who dares to resurrrect the notion of managed care as a good thing earns points for risk-taking.)  And then I was also entertained by the meta-commentary offered by Politico today--not about a specific poll on health care reform, but about all the polling on health care reform, and basically the one conclusion you can draw from all of the health reform polls is that most average citizens either don't know squat about the details of reform legislation, or, they're hopelessly confused. 

If I've done anything to add to that confusion with this blog, I apologize.  The road to health reform is paved with good intentions.

Back soon.

Are we there yet?

Many years ago, I went to law school, passed the New York State bar, and then never practiced an hour of law subsequent to that time.  I wanted to promote social change using communications and policy advocacy as my tools of choice, not the law.  But even though I found law school to be, on the whole, a fairly miserable experience, I did learn some vital lessons there about what the law can and can’t do to change institutions and people in our society.

Our lives are fundamentally governed by our political/legislative system that in turn governs other systems, like the law.  The air we breathe, food we eat, the schools our children attend or don’t attend—all of this, influenced by law.  But most of the time, we’re not aware of the laws and legislation and regulations that are governing our existence—and even if we are, we may not care about them very much.  Because unless we’re actually breaking the laws, and are then caught and punished, we’re often living quite comfortably within the legal limits imposed on our existence.  E.g., I don’t consciously think about the speed limit when I’m driving to and from work every day, I’m just sort of automatically trying to not drive like a speed demon maniac. 

The possibilities of aligned interests on health care

Margaret Stanley, former executive director of the Puget Sound Health Alliance, writes about the value of bringing diverse stakeholders into local alliances to reform health care.

As national leaders have learned again and again, assembling a fractious group of doctors, hospitals, insurers, businesses, patients and public officials around something as complex and divisive as overhauling health care isn’t easy.

But nowadays, as reasonable, well-intentioned people try to reach agreement on health reform in the midst of the ranting and clouds of misinformation, reaching consensus is especially important, because everyone’s got a role to play in making our health care better. 

From what I can tell, it may be easier to achieve true consensus around health care reform at the local level.  That’s why much of my hope for a real health care overhaul rests on the power of local organizations, like the one I headed for three years, the Puget Sound Health Alliance.  In a few years, we were able to forge partnerships across stakeholder lines to improve the quality and efficiency of health care across the Greater Seattle region. 

$650M for community prevention is milestone on road to reform

Jeff Levi, executive director of Trust for America's Health, writes about how stimulus funds  for community prevention will create a laboratory for what might be achieved with health reform.

The Administration’s announcement Thursday that $650 million in stimulus money will be made available for community prevention and wellness programs is a defining moment for public health in America. It is also an important down payment on the road toward real health reform that will help make Americans healthier.

With two-thirds of Americans overweight or obese and one in five Americans still smoking, this initiative, called Communities Putting Prevention to Work, is tackling two of the biggest health crises in the United States head on.  It will help reduce rates of preventable diseases and give millions of Americans the opportunity to live healthier, higher quality lives. Evidence-based community prevention programs have shown success in improving nutrition, increasing physical activity, and preventing tobacco use by making healthy choices easier choices forAmericans.

What is unique about this initiative is its scale. The program, funded through the American Recovery and Reinvestment Act, will earmark funds for approximately 30 to 40 communities around the country and to states to build or expand upon programs that prevent chronic disease and obesity by addressing physical activity, nutrition and tobacco use. Potentially, it will direct as much as $10 to $20 million to larger cities, representing one of the great advances for prevention programs that this country has seen in decades.

The program will give strong priority to communities that suffer a disproportionate share of preventable chronic diseases and where leaders are able to assemble a communitywide consortium of partners, including the local and state health departments, schools, businesses, community and faith-based organizations, health plans and health centers. At the end of the day, these programs will be the laboratory for showing what results we can have if we invest more heavily in wellness and prevention.

At the end of the day, these investments will be the laboratory for showing what results we might achieve if we invest more heavily in wellness and prevention.

We are convinced they will have a big payoff. In 2008, Trust for America released a study, Prevention for a Healthier America, which found that for every $1 spent on proven community-based disease prevention programs, the county could net a return of $5.60 in health care costs within five years.   On Monday, we’ll release a Compendium of Proven Community-Based Prevention Programs report, along with the New York Academy of Medicine, featuring a range of evidence-based, disease prevention programs that have shown results for improving health and reducing costs.

Finally, this initiative through the American Recovery and Reinvestment Act is a milestone towards the recognition that health reform must start with prevention in order to be successful.   We must take this as a down payment towards the creation of a dependable annual funding stream to allow hundreds of additional communities around the country to benefit from these programs. The future health and wealth of our country demands we improve the health of Americans, not just how we pay for our care.

At yesterday’s briefing, I asked HHS Secretary Kathleen Sebelius where prevention programs ranked on her priority list for health reform legislation.  She replied that it was at the very top – as it was for both the First Lady and President Obama.  Between now and the end of the year when legislation lands on the President’s desk to be signed, I believe it’s the role of the public health community to cement that support, from Congress as well as from the Administration.

To learn more about the Communities Putting Prevention to Work initiative, visit http://www.hhs.gov/recovery/programs/cdc/chronicdisease.html

 

America's uninsured: How bad do the numbers have to get?

Lynn Blewett, Director of the State Health Access Data Assistance Center (SHADAC), writes about the latest numbers on Americans who lack health insurance.  The Alliance for Health Reform sponsored a lunchtime briefing on the new figures today.

Every year, the US Census Bureau releases estimates of how many Americans lack health insurance, and this number then becomes embedded in numerous media reports and speeches that focus on health reform.  The most recent estimates from the US Census Bureau show that the number of uninsured Americans continues to grow, increasing by 600,000 individuals between 2007 and 2008.  There are now 46.3 million individuals in the US without any health insurance coverage.   The estimates also show the continued deterioration in employer-based coverage.  The number of individuals receiving health insurance coverage through their employer dropped from 177.4 million to 176.3 million individuals. 

Waiting

I haven’t written much here lately, in part because running this blog lately has mostly been about me holding the door open for some very distinguished guests to have their say about health reform.  I’m not going to say a peep on this blog if the likes of last week’s commentators are speaking up, because if that’s happening, my job becomes about getting out of their way and adding their contributions to the rest of the blogosphere whenever possible.

I will say, though, that I’m feeling a little exhausted by the emotional highs and lows of health reform in 2009.  The speech last week, the bated breath for the Senate Finance bill, the constant polling.  I feel like there are lines being drawn in the sand every day.  It’s usually a communications professional’s dream to have this level of media coverage devoted to the topics one works to promote; and yet much of the media coverage makes me sick to my stomach with anxiety and, you know, plain old disappointment. 

For health reform to work for all Americans...

Bruce Siegel, director of the Robert Wood Johnson Foundation’s (RWJF) Aligning Forces for Quality (AF4Q) initiative and the RWJF legacy program, Expecting Success: Excellence in Cardiac Care (Expecting Success), writes about collecting race, ethnicity and language data.

In the medical profession, we diagnose problems before we attempt to treat them.  It shouldn’t be any different when we try to fix our health care system.

As Congress focuses on expanding health coverage and reducing cost and waste in the health care system, an important question is: how will we make health care not only more efficient, but better for patients and families from all racial and ethnic backgrounds? 

It starts with working with the best possible data. We need to know who’s  not receiving high quality care so we can target our efforts. Reams of research have shown that racial and ethnic disparities persist despite efforts to reduce them. To address these gaps in care, hospitals, medical practices and health plan members  need precise and standardized data on patients’ race, ethnicity and primary language. 

Reducing disparities and enhancing data collection have been discussed in many of the health reform proposals in Congress. If included in the final legislation and as health care systems continue to work to close the gap, guidance and best practices on how to do this will be needed.

The Office of Management and Budget (OMB) has a standard set of race and Hispanic ethnicity categories that are widely used (race categories: Black or African American, White, Asian, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Is¬lander;  ethnicity categories: yes or no in reference to Hispanic/Latino ethnicity), but that is not enough.

A recent report by the Institute of Medicine (IOM) recommends that health care organizations continue to use the OMB categories and add more detailed ethnicity categories (known as granular ethnicity and based on a patient’s ancestry), which will help organizations better identify disparities and move away from broad categorizations of people. For example, in very diverse communities such as Miami, “black” can mean a lot of things and include many cultures, making more specific categories such as Haitian or Bahamian useful. The IOM also recommends using categories to assess language needs (ratings of spoken English language pro¬ficiency and a patient’s preferred language for health-related encoun¬ters).  Understanding a patient’s language needs will increase the ability to communicate in medical settings, which is critical to providing and receiving high-quality care. The report suggests that organizations list location-relevant categories and provide a space for patients to self-identify their ethnicity or language if it is not listed.

With better information, health care organizations can better understand the populations they serve, detect disparities in care, design actual solutions to improve care and evaluate progress. Through our work with two RWJF programs, Expecting Success and Speaking Together: National Language Services Network (Speaking Together), we have done just that. We have found that more detailed data enables us to better develop targeted quality improvement interventions for more specific populations.

As part of the Expecting Success program, we worked with 10 hospitals to develop and share tools for improving cardiac care for African-American and Hispanic patients with acute myocardial infarction or congestive heart failure. Hospital leaders want to believe that their hospitals provide equal care regardless of a patient’s race, ethnicity or primary language, but few know for sure. Without uniform standards for collecting this information, there is no way of knowing if all patients receive the same level of care.

The Expecting Success hospitals established standardized collection of patient race, ethnicity and language data. For the first time ever, the hospitals analyzed 23 cardiac care quality indicators by patient race, ethnicity and language. Although some had to face the reality that there were disparities in care in their hospitals, they were better equipped to address these gaps.

Several questions arose as the hospitals analyzed their race, ethnicity and language data such as “Why are some Hispanic patients consistently not receiving all discharge instructions?” and “Why are readmission rates so much higher for minority patients?”. These questions prompted the hospitals to design interventions to specifically address these issues. As they developed these and other programs, they were able to compare data on core measures before and after implementation to help assess their efficacy and adapt their approach as needed.

In Speaking Together, an initiative modeled after the Expecting Success program, we worked with 10 hospitals to improve the quality and availability of language services. For many patients whose first language is not English, language services are integral to getting the right care at the right time. An organization’s ability to provide appropriate language services depends on its ability to accurately screen for language needs of its patients and to identify patients’ preferred language for health care encounters—data collection is  fundamental. Without this information, we are trying to diagnose and treat a problem with a limited exchange of information.

At the beginning of Speaking Together, several hospitals were collecting language data, but there was room for improvement. To increase screening for patient language needs, hospitals used a combination of efforts, including using data to open a discussion with the leaders of registration and scheduling; training staff on screening for language needs; programming reminders in the registration and scheduling screens to prompt staff to complete the language field; using scripts for language screening; and integrating demographic information with other electronic systems in the organization. At one hospital, screening rates went from 60 percent to more than 80 percent. At another hospital, screening rates improved from approximately half of patients screened to nearly all patients screened. The data collected through these screening efforts enabled the hospitals to more accurately identify which languages were spoken by their patients, improve their overall language services and deliver safer, higher quality care.

In both of these projects, the ability to reduce disparities began with the knowledge that we gained through data collection. As we work to reform our health system to improve care for all, we need to ensure that our health care organizations are actively collecting information on our patients’ race, Hispanic and granular ethnicity, and language needs. We know the symptoms of poor-quality, unequal care, but to truly diagnose it and treat it, we need the data.

Physicians support the public option

Salomeh Keyhani and Alex Federman from the Mount Sinai School of Medicine write about recent findings from a survey of physicians on health reform.

The health reform debate has aired out a number of issues about how we can do better at health care, as a country, and one issue that consistently gets zeroed in on—even though it’s by no means the only issue—is whether health reform legislation includes a public insurance option, or not.  Over the last year, polling data has consistently shown majority support for the inclusion of a public option in the final health care reform legislation.  We knew what many of our physician colleagues felt about the public option--they all supported it. They thought of the public option as a moderate solution to unite everyone in covering the uninsured, a policy proposal that tried to sidestep the failures of the past—you could keep your private insurance if you liked it, you could buy private insurance subsidized by the government, or you could buy a public plan similar in design to Medicare.

However, on the national stage, many members of Congress were denouncing the public option as government-run health care, and declaring it would never pass the Senate.  In addition, the AMA initially appeared to be supportive of private-only health care coverage expansions.  We wondered whether the voices of all physicians were being heard.  Were our colleagues who supported the public option among the minority or majority of physicians in the field? 

The high cost of health care: getting past denial

      

Jonathan S. Skinner, Elliott S. Fisher, and Jonathan Sutherland of the Dartmouth Atlas Project at the Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth College write about the opportunities to pay for health care reform by reducing unnecessary spending.

The President’s recent speech called on Congress to move forward with much needed health care reform.  He wisely argued that reducing the waste in our current health care system can help provide the savings needed to cover the costs of expanding coverage to the uninsured.  This might appear to be obvious – many studies (including this one from the Commonwealth Fund) have shown the U.S. spends twice as much as other countries on health care, yet often lags behind in quality.  Furthermore, a number of studies from the Dartmouth Atlas group (here and here) have pointed to the dramatic differences in both levels of health care spending -- $16,351 per Medicare beneficiary during 2006 in Miami, compared to $6,604 in Richmond Virginia – and the apparent lack of better outcomes in these higher cost regions.

But not everyone is convinced.  One recent critic today even claimed that all regional variations in spending can be justified by medical need and poverty: The reason why Medicare spends so much more for patients in Newark, N.J. than it does for patients at the Mayo Clinic in Minnesota is because people in Newark are poorer and sicker.   In a recent article published online in the New England Journal of Medicine, we test this hypothesis rigorously using a large nationally representative sample of more than 15,000 Medicare enrollees.  By using individual data reporting income, health status, price-adjusted Medicare expenditures (to account for the fact that cost-of-living in New York is greater than in Oklahoma City), and other factors, we sought to gain the most accurate picture of what explains regional variations in spending – and more importantly, what doesn’t.

Listening and doing on health reform

Risa Lavizzo-Mourey, President and CEO of the Robert Wood Johnson Foundation, writes about her reaction to President Obama’s speech on health care reform last night.

I find it difficult to inventory all of the thoughts and reactions I experienced while listening to President Obama’s speech on health care reform last night. 

How to describe my listening experience?  Most of all, it was about how one might feel when one of the most important conversations in the country is centered on issues that you care deeply about, issues that you’ve been working on for decades. Perhaps it’s the way that athletes feel when they qualify to compete in the Olympics: suddenly, all of the years of training and hard work are put on display, center stage. And even though some of the most elite athletes are jockeying for position and aiming for the gold medals, for many of the other athletes, it’s also thrilling to simply be there, in common cause for a common purpose.

Last night’s speech, and all of the events of 2009 that led up to it, tell me that this is our Olympics.  This is our moment, when organizations like RWJF—and we are one of many organizations dedicated to the causes of health and health care—are seeing the fruits of our work occupy center stage.  Like those athletes, we’ve been working at this for years and years—and by “this,” I mean, we haven’t been working on getting any one bill or plan on health care passed on Congress, but we most certainly have been working on helping Americans lead healthier lives and get the quality care they need.  Because it’s RWJF’s mission to do so.

As a philanthropic organization, it is absolutely not our role to tell our government leaders what they should do when it comes to passing a bill to reform health care.  However, the conversations on what this legislation should look like have swung mighty close to the circles in which we work.  Our grantees and partners have been living and breathing these issues for years, developing the research and demonstration projects that have helped document the extent of our health and health care woes and shine a light on potential solutions.  Now, what they’ve learned—about why we need to get more Americans covered, or how to deliver high-quality, high-value care—is helping inform this national discussion. 

Therefore, it would be disingenuous of any one of us at RWJF or among our partners, myself included, to say that we don’t have an important role to play in these great events and that we didn’t care deeply about what was said last night.  What if you’re a teacher who cares deeply about the work you do—would you be able to divorce your experiences and knowledge from a national discussion on education in America?  I don’t think so. 

So I’ll just come right out and say it:  I was greatly moved by last night’s speech—as I’ve been moved by so many things that have happened this past year.  Our country, as a whole, has been through great distress and turmoil—some very tough things have happened to compound the challenges many Americans were already facing in accessing better health care and understanding how to live healthier lives.  Last night’s speech reminded me of how badly we need this, this thing we call health reform.  

 

What a myth is not

More commentary on recent news and a round-up of recent posts is forthcoming, but in the meantime, Elizabeth McGlynn, associate director at RAND Health, responds to an op-ed about health reform that appeared in the Wall Street Journal on August 31.   

As a researcher, it is my practice to bring the relevant facts to any policy discussion.  My work is specifically designed to provide evidence that can inform policy decisions. One highlight of my career was leading a team of researchers in a set of RAND Corporation studies where we examined the quality of care that Americans receive, concluding that American adults receive 55 percent of recommended medical care. 

Our research results -- especially that 55 percent finding -- have been quoted extensively by leaders and experts who are seeking to improve the way the nation pays for and delivers health care. What we found in this series of studies points to one of the things we need to change about American health care: we need to do a better job making sure people get the care they need. 

In a recent op-ed published in the Wall Street Journal, Jerome Groopman and Pamela Hartzband characterized the 55 percent finding as one “myth” in the current health reform debate. Their comment suggests our finding was something conjured up from someone’s imagination.  Far from it! The study was conducted at one of the nation’s leading research organizations, supported by the well-regarded Robert Wood Johnson Foundation, and vetted through the peer and editorial review process at the New England Journal of Medicine. Hardly the process used to manufacture myths.
 
Groopman and Hartzband dismiss the finding as a myth because of certain “flaws” in the study. I would be the first to admit that, as with any study, ours was not perfect. But our study was a significant undertaking that used the best and most-extensive methods ever assembled to examine the quality of medical care delivered in the United States. We addressed all of the issues they raise about potential shortcomings when we first published the results of the study in 2003. For example, Groopman and Hartzband criticize the study because we didn’t get medical records from everyone and in some cases we didn’t get records from all of the doctors who saw some of our study participants.  However, they chose to ignore the careful testing we did to see whether fixing either of these limitations would have changed our findings significantly. We found that the results would have been the same. They point out that while the medical records in our study showed patients received flu shots just 15 percent of the time, patients in our study reported they got flu shots 85 percent of the time. However, they failed to acknowledge that we used the 85 percent number when arriving at our overall results.  And again, our conclusions and findings were subjected to the tests of our peers and others who ultimately agreed that our methods were sound. 

It appears that the main point of the op-ed is to argue that any health reform legislation will necessarily prevent doctors and patients from talking about who should get what health services.  It seems to me that most people hope that we can find a way to improve the care Americans receive, eliminate unnecessary or wasteful care, and at the same time, do a better job of delivering the care that Americans really need. With that in mind, I find it all the more frustrating that the Groopman and Hartzband opinion piece uses misinformation and misinterpretation to confuse the debate about health reform. This is exactly what the doctor should not order. 

Regulations and health care reform: the devil's in the details

Peter V. Lee, co-chairman of the Consumer Purchaser Disclosure Project (CPDP) and executive director for national policy of the Pacific Business Group on Health, writes about how current efforts to regulate physician reimbursement for Medicare shed light on the importance of the regulatory process that would follow any health reform legislation.

Organizations interested in promoting better, more affordable and accessible health care are not only weighing on the national reform debate – last week, many of these organizations weighed in as a group on regulatory proposals to change how the Centers for Medicare and Medicaid Services (CMS) reimburses doctors.  

“Many of the proposed changes represent steps in the right direction,” the group said in a letter to acting centers Administrator Charlene Frizzera, “but they are incremental and marginal improvements where bold changes are required.”

A sustainable healthcare system

Mike Chernew, a professor and economist on health policy at the Harvard Medical School, writes about the topic of health care costs and health reform. A piece by Dr. Chernew and others appears today in a special themed issue of Health Affairs and an article on the associated study appears today in the New York Times here. 

As the debate surrounding health care reform enters its final phases, it is not surprising that cost containment is among the last, most intractable issues of contention.  The central question often seems to be: ‘how can we achieve enough savings from the system, or raise enough money, to finance reductions in the number of uninsured?’  This is admittedly a crucial question, but, for several reasons, answering this question is insufficient and framing the question this way is distracting.

First, cost containment is inherently controversial.  One sector’s costs are another sector’s revenues and the laws of accounting dictate that we can only save money by paying less or doing less. Paying less inevitably raises the opposition of providers.  If we could save enough money by keeping people healthy, and thereby doing less because we need to do less, cost containment would not be so controversial (though provider revenue, and likely profits, would still fall).  However it seems unlikely that this most rosy of cost containment strategies will be able to generate sufficient savings. Cutting out waste is also appealing, but one person’s waste is another’s valued care and the process of identifying waste often leads to charges of rationing or stinting on care.  It seems unavoidable therefore that any realistic cost containment strategies will be distasteful.

Don't walk away from reform

Chris Jennings and Mark McClellan, Co-Directors of the Leaders' Project on the State of American Health Care, discuss the importance of bipartisanship around health reform and the feasibility of a bipartisan solution as Congress returns from summer recess.

Tonight, the Robert Wood Johnson Foundation will honor Senators Baker, Daschle and Dole for their work with the Bipartisan Policy Center on the Leader’s Project on the State of American Health Care.  We were pleased to support the Leaders in this important effort, and it has reminded us that what unites us as a nation is far greater than what separates us. 

Yes, the thermometer wasn’t the only thing heating up this past August as members of Congress returned to their districts for recess.  Democracy is often loud and sometimes messy, but we are proud to live in a nation where everyone gets a voice and so many people use it on critical issues like health reform.

Replacing the shouts of recess with the deliberations of research

Jim Marks continues the discussion about how prevention can be scored.  This post first appeared here as part of Jim's ongoing gig with the Huffington Post. 

During the August congressional recess much of the coverage on health care reform has been spent showing us the cacophony of shouts and yells heard around the country during Town Hall meetings.

But at the same time, with less fanfare and attention, a more measured and productive conversation has been occurring. One that actually has the potential to help make us a healthier country AND provide us with a more cost effective system of care.

Since my August 5 post, “What If Benjamin Franklin Ran the Congressional Budget Office?,” there has been growing interest and attention surrounding the methods of the Congressional Budget Office for scoring costs and savings in general and more specifically as it relates to health reform.

Take Five for health reform

David Colby wraps up his summer reading recommendations for health reform.

I’m going to wind down my summer reading series on health reform because, well, summer’s almost over and Congress is getting back to work.  Although I’ve been somewhat lighthearted in making my reading recommendations, I do hope you know that I know that reading health policy research may not go down as easily as the latest John Grisham or Jennifer Weiner novel (at least, for some of us).  These recommendations were made with two goals in mind—to remind people who care about health reform that facts and sound analysis can and should trump sensationalistic fiction, and to point you to the best examples of what we’ve got by way of facts and sound analysis. 

Before summer officially ends, though, I’m going to take some time to sit on my deck and listen to Dave Brubeck’s Take Five, which is celebrating its fiftieth anniversary this year.  And in that spirit, I’ll encourage you to also ‘take five,” by recommending five topics to learn more about. These are the topics that have dominated health reform discussions in 2009, and they also happen to be five topics on which we can offer you good reading material.  And once again, I’ve tried to make it easier for you readers out there by giving you the gist of what these topics are really about, using literary references that some of you may enjoy. 

Civil health reform discussions, still happening in Maine

  Lisa Letourneau, the executive director of Quality Counts for ME, and Ted Rooney, project director of Maine’s Aligning Forces for Quality project write about a forum held last week to discuss health reform efforts in Maine.

In Maine, we know quality—from our famous hunting boots to our favorite shellfish, we produce good stuff.  That commitment applies to how we feel about health care, too.  Last week, we gathered more than 150 Mainers at a forum in Lewiston to talk about what we, in this state, are doing to improve care.  Our event was part of a series of gatherings that have been taking place all over the country, in communities working under RWJF’s Aligning Forces for Quality initiative.  At these events, we talk about what we’re doing to improve our health care, in the places where we live and work, but we also talk about how our work dovetails with the national discussions on health care reform. 

Bending the cost curve in health care

Leonard Schaeffer, founding chairman and CEO of WellPoint, the nation’s largest health insurer, writes about a recent effort to develop a consensus on strategies to contain costs and improve value in health care.

My first involvement with national health care reform was in the 1970s when I served as administrator of the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services).  Since then, the academic community has made great progress in defining the health care cost problem and analyzing techniques to deal with it. And we now have technology to capture data to create the feedback loops necessary for a true health care system. The real challenge is to convince elected officials that practical solutions exist and should be enacted into law.

As the health care reform debate intensified this summer, RWJF and the Brookings Institution brought together a diverse group of health policy experts, economists and executives to identify practical and feasible steps to slow health care cost growth while improving value.  Our group’s effort was a microcosm of what needs to happen more broadly: Strong ideological biases were set aside to reach consensus on a list of practical strategies to reduce the rate of increase in health care costs. 

Our paper, “Bending the Cost Curve; Practical, Realistic Strategies to Contain Costs and Improve Value,” describes the consensus list.  We recommend that policies be implemented in a series of steps that link short-term foundation-building with longer-term systemic change.  Over time, these policies will create new incentives to change the behaviors of critical stakeholders.  Our recommendations would reform payment systems, regulations and institutions through four interrelated sets of activities:

• Investing in better information and tools as a foundation to guide and support a reformed health care system;
• Transitioning to accountable payment systems that reward providers for providing lower-cost, high-quality care;
• Restructuring the health insurance system to lower the rate of premium cost growth; and
• Supporting better individual choices to enhance the patient role in improving health and lowering costs.

We will disseminate our consensus document widely to demonstrate that feasible strategies do exist to lower the rate of growth in Medicare and national health care spending.  We can begin to bend the cost curve now in ways that link lowering costs with improved quality and greater value for every health care dollar we spend.