Bending the Cost Curve

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by Greenbeard, Sep 12, 2010.

  1. Greenbeard
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    Greenbeard Gold Member

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    It seems there's been some additional interest this week in what bends the health care cost curve--will reform do it? So it's worth walking through two syntheses of options that came out within the past few years.

    The first, "Bending the Curve: Options for Achieving Savings and Improving Value in U.S. Health Spending," came out of the Commonwealth Fund Commission on a High Performance Health System in 2007. They offer 15 suggestions, falling under 4 categories:

    Producing and Using Better Information
    • Promoting Health Information Technology
    • Center for Medical Effectiveness and Health Care Decision-making
    • Patient Shared Decision-making
    Promoting Health and Disease Prevention
    • Public Health: Reducing Tobacco Use
    • Public Health: Reducing Obesity
    • Positive Incentives for Health
    Aligning Incentives with Quality and Efficiency
    • Hospital Pay-for-Performance
    • Episode of Care Payment
    • Strengthening Primary Care and Care Coordination
    • Limit Federal Tax Exemptions for Premium Contributions
    Correcting Price Signals in the Health Care Market
    • Reset Benchmark Rates for Medicare Advantage Plans
    • Competitive Bidding
    • Negotiated Prescription Drug Prices
    • All-Payer Provider Payment Methods and Rates
    • Limit Payment Updates in High-Cost Areas

    If you don't feel like thumbing through a report but you want a quick, one paragraph overview of what any one of those options is, you can just click it on this interactive feature accompanying the report.

    The other report, Bending the Curve: Effective Steps to Address Long-Term Health Care Spending Growth, was put together by a diverse group of experts spanning the ideological spectrum and released by Brookings a year ago this month. It's a bit shorter: whereas the Commonwealth report is 114 pages, this one is just 11.

    They break their report in four general areas to be addressed, with specific key reforms suggested within each:

    Building the Necessary Foundation for Cost Containment and Value-Based Care
    • Key Reform 1: Ensure Investments in Health IT are Effective
      • Link "meaningful use" health IT bonuses to achieving better results
      • Create interoperability and provider community standards
      • Fund technical support programs
    • Key Reform 2: Make Best Use of Comparative Effectiveness Research (CER)
      • Create an entity to allocate CER funding
      • Emphasize areas of medical uncertainty
      • Protect providers and insurers from liability when they follow evidence-based pratices
    • Key Reform 3: Improve the Health Care Workforce
      • Create incentives for states to amend the scope of practice laws to allow for greater use of nurse practitioners, pharmacists, physician assistants, and community health workers
      • Align Medicare payments
      • Reform graduate medical education payments
    Reforming Provider Payment Systems to Create Accountability for Lower-Cost, High-Quality Care
    • Initial Reforms: Adjust Medicare and Medicaid Fee-for-Service Payment Systems
      • Broaden bundled payments
      • Expand the use of pay-for-performance
      • Increase payment rates for primary
      • Provide additional payments to physicians whose practices serve as "patient-centered medical homes"
      • Ensure Medicare payments support the use of allied health professionals
      • Reduce payments for care of low value relative to cost
      • Increase spending on programs to reduce waste, fraud, and abuse in Medicare
      • Enable Medicare Prescription Drug Plans to share in overall cost savings created by more effective use of prescription drugs
      • Establish a regulatory pathway for follow-on biologics
    • Key Reform 1: Build New Payment Systems for Provider Accountability
      • Pilot Accountable Care Organizations
      • Pilot "enhanced episode-based payment" systems and other promising payment systems
      • Incorporate other bonuses into a transition to accountable payment systems
    • Key Reform 2: Apply Pressure to "Non-Accountable" Medicare Payments
      • Establish "Virtual ACO" incentives
      • Freeze market basket updates for two years for providers not participating in accountable payment systems
    • Key Reform 3: Improve Payment/Coverage Flexibility and Rapid Learning to Achieve Lower Costs and Better Quality
      • Expand and streamline CMS's piloting authority and resources
      • Support public-private regional collaboratives
      • Empower an entity to improve the value and ensure the long-term sustainability of Medicare and Medicaid by proposing policy changes that are subject to fast-track, up-or-down votes in Congress.
      • Reform medical liability to increase support for providers and insurers to make decisions based on high-value, evidence-based practices
      • Reform anti-trust laws and create processes for expedited waivers from anti-gainsharing an Stark laws
    Improving Health Insurance Markets
    • Key Reform 1: Restructure Non-Group and Small-Group Markets around an Exchange Model that Promotes Competition on Cost Reduction and Quality Improvement
      • Focus insurer competition on cost and quality through requirements for guaranteed issue, limited health rating, and risk-adjustment across insurers; for market stability, these reforms must be undertaken in the context of an enforced mandate that individuals maintain continuous, creditable basic coverage
      • Establish health insurance exchanges
    • Key Reform 2: Reduce Inefficient Subsidies to Employer-Provided Health Insurance
      • Cap the existing income tax exclusion for employer-provided insurance
      • Adjust the cap based on plan demographics and location
    • Key Reform 3: Promote Competitive Bidding in Medicare Advantage
      • Set local benchmarks at the average of bids
      • Establish a significant quality bonus
      • Consider a transition to including Medicare fee-for-service in the bidding system
    Supporting Better Individual Choices
    • Key Reform 1: Reform Medicare Beneficiary Design to Promote Value and Beneficiary Savings
      • Restructure Medicare Parts A and B
      • Establish tiered copays
      • Reform Medicare supplemental plans
      • Enhance and publicize provider quality and cost information
      • Increase flexibility to alter benefits over time to reflect best available value-based standards
      • Assure that these steps are designed to result in lower beneficiary spending
    • Key Reform 2: Promote Prevention and Wellness that Reduces Cost
      • Target obesity reduction through price incentives
      • Allow premium rebates for measurable health and risk-factor improvements, provided that all beneficiaries have the opportunity to save money
      • Establish public health outcome-based accountability
    • Key Reform 3: Support Patient Preferences for Palliative Care
      • Provide an opportunity for Medicare beneficiaries to file and regularly update advanced directives that truly reflect their personal preferences for care
      • Create a liability safe-harbor for providers adhering to advanced directives

    If you're interested you can also peruse the CBO's 2008 Budget Options, Volume 1: Health Care, which walks through 115 options related to health care reform. These aren't necessarily about bending the cost curve and they don't look at national spending; since it's the CBO, its focus is entirely on the effects of various policy options on federal spending. But most of the cost control options mentioned in the two reports above appear in there.

    So these are the suggestions experts have offered for bending the cost curve--this is what the policy options for doing that would look like. And as you may or may not know, quite a few of these are now federal law.
     
    Last edited: Sep 12, 2010
  2. boedicca
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    boedicca Uppity Water Nymph Supporting Member

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    Here's the Cliff's Notes version: Price Controls, Taxes, and Rationing.
     
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  3. Oddball
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    Oddball BANNED Supporting Member

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    Great...Another text wall of promises, meaningless technocratic statistics and nebulous bureaucratese jargon, meant to suffice for reality.

    When has the federal gubmint ever created a program that ever came in below cost estimates and delivered anywhere near what it promised, let alone more?

    If Medicare/Medicaid are any such real-world examples that the feds can "bend the cost curve", America is sooooooooo screwed.
     
  4. CrusaderFrank
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    CrusaderFrank Diamond Member

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    Here's where it works best: Patient -- Doctor

    Here's where we are now: Patient -- Government -- insurance companies -- regulations -- 2,000 page new law that has people reporting all purchases above $600 to IRS -- Doctor

    Here's what's recommended: Patient -- Government
     
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  5. CrusaderFrank
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    CrusaderFrank Diamond Member

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    Walmart wakes up every day and finds new way to bend their cost curve. Our Health Care system needs to be Walmatized
     
  6. CrusaderFrank
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    CrusaderFrank Diamond Member

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    So that was before ObamaCare, does ObamaCare incorporate any of it all of it?

    What's the first date we can repeal ObamaCare?
     
  7. CrusaderFrank
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    CrusaderFrank Diamond Member

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    Greenbeard, Why was reporting purchases all over $600 to the IRS included in ObamaCare? Does that bend the cost curve?

    Is that why hiring 16,000 new IRS agents was included in ObamaCare?
     
  8. CrusaderFrank
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    CrusaderFrank Diamond Member

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    Producing and Using Better Information

    * Promoting Health Information Technology (Aka: more government)
    * Center for Medical Effectiveness and Health Care Decision-making (Aka: more government)
    * Patient Shared Decision-making (Seriously? Talking to the patient is a new radical idea?)
     
  9. Greenbeard
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    Greenbeard Gold Member

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    Goodness, six quick responses and not one about bending the cost curve or improving quality. Shocking!
     
  10. boedicca
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    boedicca Uppity Water Nymph Supporting Member

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    That's because ObamaCare doesn't bend the cost curve down nor does it improve quality.

    Instead, it is yet another program in which Big Government takes money from the relatively powerless in order to benefit select special interests. In this case, the special interests are Big Insurance, Big Pharma, Public Employee Unions, and Big Government itself.
     

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