The Brookings Institution recently proposed a framework for health care reform in their report, “Person-Centered Health Care Reform: A Framework for Improving Care and Slowing Health Care Cost Growth,” the third released in their “Bending Curve” series. The person-centered focused report is centered on one core goal of supporting sustainable lowered costs with higher quality care. The proposals are driven by the persistent gaps in quality and safety of care. As mentioned in the report, the plans contain similar elements to the President’s budget and the House and Senate Budget resolutions, which include targeted spending reductions in federal health care programs. The Bipartisan Policy Center and Simpson-Bowles have put forth similar plans which emphasize saving estimates that range from $560 – $585 billion. The authors estimate to achieve $300 billion or more in savings within a decade.
The policy reforms mentioned in the first report fell into four major categories:
- Implementing electronic data exchange with timely availability
- Regulation to support providers and changes in financing
- Value-based changes in insurance design and regulation to support consumers
- Insurance market reform to encourage higher-value care
The second report highlighted specific changes in Medicare, Medicaid, private insurance programs and lightly touched on the Affordable Care Act (ACA). Improvements have been made developing a better electronic infrastructure to measure quality, but the private sector still aims to improve value.
“For example, while accountable care organizations (ACOs) that track quality and patient-level costs represent only a fraction of payments (less than 20 percent), they are growing rapidly in both Medicare and the private sector.”
The updated recommendations in the second report were guided by following principles:
- Acknowledging the concept of achieving better health and fewer complications
- Supporting this goal with aligned reforms for better provider payment, benefit design, health plan payment and competition
- Describing the steps needed to build on promising policy reforms currently in place
- Monitoring progress along the way for necessary adjustments
If the following are successfully implemented, the group expects long-term savings to exceed $1 trillion over twenty years. Among the recommendations:
- Transition to Medicare Comprehensive Care (MCC) and away from Medicare’s traditional fee-for-service model.
- Transition to Person-Focused Medicaid that includes extensive monitoring and evaluation. The process would routinely track quality of care and per capita growth and states with improved cost trends would keep a share of their savings.
- Reforms for private health insurance markets by limiting the exclusion of employer-provided health insurance benefits.
- Promote effective antitrust enforcement. Improve cost and quality transparency by implementing consistent methods across providers and payers. For instance, restrict “gag” clauses.
- “Facilitate the adoption of payment reforms by providers in Medicare and Medicaid to match value-based payment reforms in the private sector.”
Written by Kim Phan, Program and Marketing Coordinator, The Institute for Health Technology Transformation (iHT²) where this was first posted.
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