Reform Update: Politics aside, policy experts agree on health reform, authors say

Given the fierce debate in Washington, D.C., over healthcare reform, here's a surprising statement: There is broad consensus on how the nation should fix U.S. healthcare, according to an article published by policy experts in the Journal of the American Medical Association.

Policymakers strongly agree on what does not work—fee-for-service, or paying hospitals and doctors by volume for clinic visits, test and procedures, wrote authors Dr. John Lewin and Larry McNeely of the NCHC and Lawrence Atkins of the NASI, who reached that conclusion after reviewing recent healthcare reform policy papers by organizations including the Bipartisan Policy Center, Brookings Institution, Commonwealth Fund, National Coalition on Health Care, Partnership for Sustainable Health Care and Urban Institute.

The Bipartisan Policy Center was launched by former Republican Sens. Howard Baker and Robert Dole and former Democratic Sens. Tom Daschle and George Mitchell.

“This agreement offers the basis for crafting the next steps in reform,” the authors wrote. They said there is consensus around value-based payments and insurance design.

The proposals call for “shifting from fee-for-service reimbursement for clinicians and hospitals to incentives for improved care quality, patient satisfaction and measured outcomes,” the authors wrote. All proposals reviewed also call for insurance incentives that will encourage patients to make healthier choices and seek high-quality care.

That consensus is “very striking, very encouraging,” said Paul Ginsburg, president of the Center for Studying Health System Change. Ginsburg, a health economist, has reviewed five of the proposals and five others in work for the Robert Wood Johnson Foundation. “They're all talking about changes in the way that healthcare is delivered that would reduce the role of fee-for-service payments” in favor of bundled payments, medical homes or accountable care.

But few “get beyond vision,” he said. The Bipartisan Policy Center included plans that would add “muscle” to policies that break from fee-for-service, Ginsburg said.

The Brookings Institution also made more concrete proposals, which the authors said could reduce federal healthcare spending by $300 billion over a decade.

The Patient Protection and Affordable Care Act, several states and some private market initiatives are testing models that seek to develop more value-based financing and delivery models, including accountable care organizations, though Medicare's test of accountable care continues to rely on fee-for-service and offers an additional financial incentive to try to curb costs.

The authors acknowledged the challenge that any healthcare reform will face—and how little is currently known about what models might be most successful. “Despite its substantial achievements, healthcare in the United States remains woefully complex and inefficient, and treading the elusive path toward sustainability will not be easy,” they said. “In addition, there are few data to support many of the recommendations.”

Other policy proposals received less consensus than value-based financing and insurance. Global spending targets, a policy recently adopted by Massachusetts, won the least support, with endorsement by the Bipartisan Policy Center and the Brookings Institution.

More assembly-line efficiency could improve U.S. healthcare costs, which is instead “producing a Rolls Royce for each patient,” two business professors argued in a blog post for Leading Health Care Innovation , a joint effort by the Harvard Business Review and the New England Journal of Medicine.

“Why can't U.S. healthcare go vastly farther in streamlining operations, standardizing protocols, and rationalizing facilities to create focused hospitals for heart surgery, hernia repairs, cataract surgery, hip and knee replacements, organ transplants, or even cancer treatment—anything that's not an emergency procedure and can be scheduled in advance?” wrote Vijay Govindarajan of Dartmouth College and Ravi Ramamurti of Northeastern University. Henry Ford slashed the cost of automobile production with the introduction of assembly lines, they wrote. That's a strategy adopted by healthcare providers in India and one that U.S. providers could also employ.

States will track and report performance measures for the Patient Protection and Affordable Care Act's health insurance exchanges, but more data from other sources might be useful to monitor progress, according to a Health Affairs blog this week by the deputy executive director and chief operating officer of the Massachusetts state insurance exchange, which has been operating since 2007.

“Beyond CMS' reporting requirements, we anticipate that there will be a need and opportunities for states to collect and analyze data from a broad array of sources to evaluate the role of marketplaces in achieving national and state policy goals as well as tactical and business-oriented metrics that measure operational efficiency, customer service and effectiveness of outreach efforts,” wrote Roni Mansur, the COO of the Massachusetts Health Connector, with co-authors Jay Himmelstein, Scott Keays and Kaitlyn Kenney Walsh.

Follow Melanie Evans on Twitter: @MHmevans