Private group suggests reforms for health care

Imagine if your doctor — before prescribing a drug or ordering a scan, lab work or some other kind of test — was prompted by a computer screen that told him whether his diagnostic or treatment plans aligned with medical evidence for best health outcomes, and then gave him the choice to change his mind and, potentially, your wellbeing.

Or, if Medicare — with its confusing, fragmented parts and differing premiums and deductions for hospital, outpatient and drug care — were collapsed into one health plan like private ones. Suppose Medicare no longer reimbursed doctors and hospitals based on a specific formula for certain services, but paid on performance, while consumers were given discounts for choosing health providers who worked in teams to provide patient-centered care, improving coordination among multiple providers.

The initiatives are part of a strategy recommended by The Commonwealth Fund, a private foundation based in New York and Washington,

Paula Burkes

D.C., that is working toward a high performance health system. At a symposium for journalists last week in New York, foundation leaders highlighted brokenness in the system and ways to fix it.

In fewer than nine months, on Oct. 1, the country, under Obamacare, is charged with being ready to enroll Americans without health insurance in expanded Medicaid plans or private plans offered through online exchanges, which will be operated by the states or the federal government.

Jan. 1 is the effective date for the biggest mandates under health care reform: All individuals are required to have insurance; employers with 50 or more workers must offer insurance or face penalties; and insurers no longer can deny people coverage for pre-existing conditions.

It’s estimated the reform will give access to 37 million people — more than the number initially enrolled in Medicare and Medicaid combined. It will be a momentous time in our history to be sure.

Experts say the problem is we’ve done nothing to control health care costs.

Health care premiums eat up an average 24 percent of yearly household incomes, while average spending per capita is $9,000 annually.

Over the past 10 years, annual public-private health care spending has grown 77 percent. Today, it totals $2.7 trillion and is growing at a rate of 3.9 percent a year. Spending comprises 18 percent of our gross domestic product — 50 percent more as a share of GDP than other industrialized nations spend — yet we don’t have longer lives and better health to show for it.

The Commonwealth Fund President David Blumenthal is a former primary care doctor who worked at Massachusetts General Hospital, where he saw the use of evidenced-based medicine, engineered into the network’s electronic health records, dramatically reduce the number of radiology tests ordered, and ensuing costs, “by simply reminding doctors of best practices at the point of making a decision.”

Building a high-performance health system, Blumenthal said, will be about “unleashing that kind of bottom-line, innovative spirit,” including standardizing claims, processing and billing services; and bundling payments for acute hospital episodes.

The Houston-based Actuarial Research Corp. has shown that The Commonwealth Fund’s initiatives would slow health care spending by an estimated $2 trillion by 2023, holding increases in national health expenditures to no more than long-term growth.

The benefit to individuals would be the real win.

“I don’t think the answer (to controlling costs) is to make a frail 85-yearold woman a better shopper,” said Stuart Guterman, fund vice president.

“There’s an alternative to rationing and taking away stuff,” Blumenthal said, “and that’s to make the system better.”