Five national organizations representing diverse constituencies involved in the nation’s healthcare system joined together in presenting consensus recommendations today for improving health care quality while lowering costs nationwide.
Calling itself the Partnership for Sustainable Health Care, the group includes prominent advocates for employers, insurers, consumers, health care providers and others. Participants include America’s Health Insurance Plans, Ascension Health, Families USA, National Coalition on Health Care and Pacific Business Group on Health.
“No single organization working alone, and no single policy approach, will achieve the lower-cost, higher-quality imperative. Moderating health costs while improving quality of care must be an all-hands-on-deck commitment,” said Ron Pollack, executive director of Families USA.
The organizations recommend a set of integrated, system-wide approaches involving both the public and private sector that they say will significantly curb the growth in health care spending and enhance the delivery of care. The organizations met regularly for more than a year to develop proposals and were supported in their work with a grant from the Robert Wood Johnson Foundation.
“We believe our health system will generate better value when consumers and providers face aligned incentives—based on evidence of what works—that reward quality care and efficient use of resources,” said David Lansky, president and CEO of the Pacific Business Group on Health.
The group made five recommendations:
- Transform the way health care providers are paid, to emphasize value of services provided, rather than volume. Partnership members believe that private and public insurance programs must make the transition from the current fee-for-service payment system to one that better rewards quality and value. They call on the public and private sectors to implement a range of alternative payment and delivery models over the next five years, in order to quantify results and spread successful models.
- Pay for care that is proven to work. Partnership members recommend a tiered reimbursement strategy that links payment directly to effectiveness. They recommend that both public and private insurers reduce payment for services that prove to be less effective and to have weaker value than alternative therapies.
- Encourage consumers to choose high-quality care. Partnership members recommend incentivizing consumers to select high-performing providers. They point to models like value-based insurance design, which offer financial incentives to consumers—such as reduced cost-sharing—when they opt for evidence-based treatments and obtain care from providers who deliver high-quality care. Traditional Medicare should be modified to allow tiered cost-sharing for beneficiaries who use high-quality providers, and drugs and services that are proven effective.
- Improve the nation’s health care infrastructure. Partnership members recommend reforms aimed at strengthening the foundational infrastructure of America’s health care system so that cost- and quality-related innovations can be implemented more effectively. They call for establishing a uniform and prudent set of quality and other performance measures to be used by both the public and private sectors to support provider payment reform, consumer incentives and healthy competition in health care markets.
- Incentivize states to improve care. Partnership members recommend establishing a gain-sharing program for states, which would encourage innovative approaches to controlling health care costs. States that participate would outline specific savings goals, with defined rewards for meeting them. States that slow the growth of total spending would be rewarded with a percentage of the savings. The recommendations include numerous ways to ensure that cost-reduction is accomplished responsibly and builds upon the access gains achieved through the Affordable Care Act.
“These five ideas are game-changers that can place our health system on a sustainable path. Together, they can provide significant long-term relief for families and businesses facing rising costs and uneven quality,” said John Rother, president and CEO of the National Coalition on Health Care. “By encouraging new forms of health care delivery and spending our health care dollars more wisely, they can produce the real health-cost reform that our elected leaders in Washington have been searching for.”
Leaders of the Partnership believe their comprehensive approach to integrate public and private sector actions toward improving the health system will help stop the ‘silo effects’ of health care, including shifting costs from one partner or sector to another.