Health­care in­no­va­tion zones could pi­lot pay­ment, de­liv­ery strate­gies

Re­form back­ers must con­tinue the ef­fort with de­liv­ery, pay­ment changes

Modern Healthcare - - Front Page -

When Pres­i­dent Barack Obama laid down the last of 22 pens af­ter sign­ing the Pa­tient Pro­tec­tion and Af­ford­able Care Act, we be­gan a new jour­ney in the his­tory of the U.S. health­care sys­tem.

For most Amer­i­cans, the jour­ney started in 2009 with the de­vel­op­ment of the re­form leg­is­la­tion that ul­ti­mately be­came law. But for those of us on health­care’s front­lines, dis­cus­sions about the need to trans­form our cur­rent sys­tem be­gan long be­fore last year.

Just as the pri­mary race for the White House kicked off, Mod­ern Health­care pub­lished my views on the sub­ject of health­care re­form in a com­men­tary (Jan. 28, 2008, p. 20). In the ar­ti­cle, I spec­u­lated on the pos­si­ble di­rec­tions we might take—if the win­ner of the pres­i­den­tial elec­tion de­cided to pur­sue a com­pre­hen­sive over­haul of health­care.

Fast for­ward to March 2010. As I lis­tened to re­marks by Pres­i­dent Obama on the his­toric pas­sage of re­form leg­is­la­tion, it seemed ap­pro­pri­ate to re­flect on how far we have come and how much fur­ther we have to go.

The new re­form law is a crit­i­cal first step to­ward that trans­for­ma­tion. In my 2008 com­men­tary, I pointed to the need to pro­vide cov­er­age and a “med­i­cal home” to each in­di­vid­ual. Un­der the new law, 32 mil­lion Amer­i­cans will be able to ob­tain in­sur­ance cov­er­age and ac­cess the high-qual­ity health­care they de­serve. The act also cre­ates a pro­gram to es­tab­lish and fund com­mu­nity health teams to pro­vide med­i­cal homes and co­or­di­nated care for in­di­vid­u­als with chronic con­di­tions.

The need to im­ple­ment bet­ter care mod­els is a crit­i­cal com­po­nent of on­go­ing re­form. In ad­di­tion to pro­vid­ing in­sur­ance, it is es­sen­tial that we bet­ter in­te­grate the de­liv­ery of care by physi­cians, hos­pi­tals and other providers, and re­vamp our cur­rent pay­ment sys­tem, which of­ten en­cour­ages un­nec­es­sary care.

In­cluded in the new re­form law is a pro­posal of­fered by the As­so­ci­a­tion of Amer­i­can Med­i­cal Colleges that could ac­com­plish th­ese goals. The es­tab­lish­ment of “health­care in­no­va­tions zones,” or HIZ, is one of the pro­grams that could be used to pi­lot new pay­ment and de­liv­ery strate­gies un­der the Cen­ter for Medi­care and Med­i­caid In­no­va­tion to be es­tab­lished by HHS Sec­re­tary Kath­leen Se­be­lius within the next year.

The HIZ pro­posal, orig­i­nally in­tro­duced as leg­is­la­tion by Rep. Allyson Schwartz (D-Pa.), would cre­ate an al­liance of aca­demic med­i­cal cen­ters, lo­cal hos­pi­tals, physi­cians, in­sur­ers and other part­ners that could de­sign and test new, more pa­tient-cen­tered mod­els of care. Th­ese mod­els would pro­mote qual­ity and “bend the curve” on costs. Aca­demic med­i­cal cen­ters are uniquely po­si­tioned to be vi­tal part­ners in th­ese zones. Home to highly trained physi­cians and sci­en­tists with the best fa­cil­i­ties, th­ese in­sti­tu­tions can in­te­grate health ser­vices, col­lect data on clin­i­cal out­comes and re­design ed­u­ca­tional pro­grams to pre­pare doc­tors for a 21st cen­tury health­care sys­tem. As part of HIZ, the na­tion’s aca­demic med­i­cal cen­ters can lead the way in the next steps we must take to achieve true re­form: align­ing fun­da­men­tal changes to the de­liv­ery sys­tem with changes in fi­nanc­ing.

While the new health­care re­form law of­fers many op­por­tu­ni­ties for mean­ing­ful change, it will also present many chal­lenges that we must ad­dress as we con­tinue the “work in progress” of health­care re­form.

Now more than ever, the na­tion must ex­pand the physi­cian work­force to ac­com­mo­date mil­lions of newly cov­ered Amer­i­cans and a rapidly grow­ing Medi­care pop­u­la­tion. Our U.S. med­i­cal schools are al­ready do­ing their part by in­creas­ing en­roll­ment. Congress must join in this ef­fort by lift­ing the caps on Medi­care-sup­ported res­i­dency po­si­tions so that fu­ture physi­cians can fin­ish their train­ing.

It is also im­per­a­tive that we re­peal the deeply flawed physi­cian pay­ment for­mula and re­place it with a new sys­tem that will guar­an­tee Medi­care pa­tients the sta­bil­ity and ac­cess to the care they de­serve. The re­cent freeze on cuts to Medi­care physi­cian pay­ments, while wel­come, is only a tem­po­rary so­lu­tion to a long-stand­ing prob­lem.

To build on health­care re­forms and con­tinue their ef­forts to re­design pa­tient care, U.S. hos­pi­tals must re­main fis­cally vi­able. The cuts to Medi­care and Med­i­caid dis­pro­por­tion­ate-share hospi­tal pay­ments in­cluded in the new law will sig­nif­i­cantly re­duce fund­ing for th­ese in­sti­tu­tions. Th­ese re­duc­tions must be care­fully mon­i­tored to make cer­tain they do not un­der­mine the na­tion’s safety net be­fore we know the out­come of cov­er­age ex­pan­sion.

We must also be equally vig­i­lant of the new In­de­pen­dent Pay­ment Ad­vi­sory Board and en­sure that any pro­pos­als it de­vel­ops to slow the growth of Medi­care spending do not pro­duce un­in­tended, dam­ag­ing con­se­quences, such as jeop­ar­diz­ing pa­tient ac­cess to the unique health­care ser­vices pro­vided by teach­ing hos­pi­tals and the clin­i­cal providers of the na­tion’s med­i­cal schools.

The jour­ney we have been on for the past year has been a long and ar­du­ous one for our na­tion. The de­bate of­ten de­te­ri­o­rated into a bit­ter blame game over whether the mar­ket or the gov­ern­ment was bet­ter equipped to “fix” health­care. The ran­corous dis­cus­sions of last sum­mer’s town hall meet­ings grew into an­gry Capi­tol Hill protests and cul­mi­nated in fright­en­ing threats against mem­bers of Congress.

This was not Amer­ica at its best. De­spite th­ese mo­ments, we have pro­duced a land­mark re­form law, the first step to­ward truly trans­form­ing health­care in our coun­try. Now, as the late Sen. Ted Kennedy said in 2008, “the work be­gins anew.”

It is es­sen­tial that we bet­ter in­te­grate care de­liv­ery and re­vamp pay­ment sys­tems.

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