Although health reform ideas have floated around Washington for years, former HHS Secretary Michael Leavitt said that the pressure imposed on the federal government by the sequester cuts has served as a catalyst for action on some off the reforms suggested in the report. Leavitt, one of 18 authors of “Bending the Curve: Person-Centered Health Care Reform. A Framework for Improving Care and Slowing Health Care Cost Growth”, spoke at an event sponsored by Brookings' Engelberg Center for Health Care Reform.
Former Senate Majority Leader Tom Daschle (D-S.D.), another author of the report who spoke at the event, said that reform and cost-cutting must come not only in Medicare and Medicaid, but also in private insurance and from systemwide changes.
The report recommends transforming Medicare into a “Medicare comprehensive-care” system in which providers receive a capitated payment influenced by care quality and patient outcome, and with per-capita spending growth limited to per-capita GDP. The authors estimate the federal government would save $120 billion from 2019-23 alone.
HHS' Office of the Assistant Secretary for Planning and Evaluation estimated that Medicare's per-beneficiary spending growth in 2012 was 0.4%, compared with 3.4% growth in per-capita GDP.
On the Medicaid side, the authors propose “person-focused” Medicaid reform that would focus on more coordinated care and deliver lower cost growth while maintaining or improving care, saving $100 billion over a decade.
The U.S. could spend $120 billion in private health plans over 10 years, the report says, with a cap on the employer-sponsored insurance tax exclusion.
Another $20 billion in savings could be achieved by expanding the CMS capitated financial-alignment demonstration project for those eligible for both Medicaid and Medicare to a permanent initiative with a pathway for faster implementation. Last month, California became the fifth and largest state to win approval to participate in the program, which has drawn concerns from patient advocates about its pace and scope.
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