Why not start with ideas they've already introduced and passed just a year or so ago? A sampling:
- Value-based purchasing in Medicare.
- In the vein of paying for value, building on quality measure advancement begun for children two years ago under CHIPRA by extending it to adults and expanding public reporting on quality.
- Incentives for accountable care.
- Upping AHRQ's in health care delivery system research and building technical assistance capacity to assist providers in implementing them.
- One of the largest patient safety initiatives in recent memory, aimed at curbing unnecessary expenditures due to preventable errors and hospital-acquired conditions, is not a price control.
- Supporting community-based prevention efforts, particularly those aimed at chronic illness (one of the big cost drivers in our system).
- Financial incentives for Medicare and Medicaid providers who adopt electronic health records with clinical support tools and quality measurement capabilities.
- Seeding models of advanced primary care aimed specifically at high-utilization, high-cost beneficiaries.
- Payment reforms to discourage unnecessary spending.
- Improved care coordination, particularly for those needing the most complex and expensive care regimes (and thus likely to benefit the most from it).
- Transitioning enrollees from institution-based long-term care to community-based care where possible.
- Learning which treatments are the most effective and using that knowledge.
- A body dedicated to testing payment and delivery system innovations to determine which ones improve quality an reduce costs, and a mechanism for using that knowledge.
Each of those has large ramifications for Medicare. For all the griping about the IPAB, its most interesting aspect is its mandate to include in its work recommendations to "improve the health care delivery system and health outcomes, including by promoting integrated care, care coordination, prevention and wellness, and quality and efficiency improvement."
Is there more that can be done (beyond simply expanding and strengthening these reforms that are already on the books)? Sure, there is. As Obama hinted at in his budget speech (and economic research quantifies) taking advantage of Medicare's purchasing power when it comes to drugs has potential, and Obama's apparent call in his budget speech for even more expansive and explicit value-based insurance design in Medicare would build on the existing value-based purchasing initiatives nicely.
Yet even though there is more to be done, suggesting the Democrats haven't offered any ideas is absurd when you realize that Ryan's ideas exist as a 70-page white power while the Democrats' suggestions are already entering the implementation phase as we speak. Seems like only a few months ago the complaint was that there were too many ideas being offered by Democrats (2,000 pages! oh no!), then only a few weeks ago the complaint was that there were too many pages of regs fleshing out those ideas coming out of CMS (you know, the folks who run Medicare). And now it's "Anybody see a Dem plan out there??" Oy.
