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Testimony on Policy Options to Promote Delivery System Reform

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Dramatic and valuable innovations in service delivery and product innovation have been made throughout the industries and organizations represented by PBGH Members. Now is the time to reward improved health outcomes, innovation and efficiency in health care.  At the April 21 Roundtable to Discuss Reforming America's Health Delivery System, PBGH Executive Director for National Health Policy, Peter V. Lee highlighted five policy approaches:

  • Transparency in provider performance and the comparative effectiveness of treatments, drugs and devices;
  • An infrastructure to support the efficient collection and sharing of information;
  • Payments that reward higher value and provide consistent incentives across both public and private sector payors;
  • Effective ways to engage patients with information and incentives to make the best decisions;
  • Policy and governance processes that incorporate the perspectives of purchasers, consumers and providers.

There is huge variation in the quality of health care, but purchasers and consumers don’t know who is or isn’t delivering the right care at the right time.  Improving quality requires sharing information about what is happening inside our health care system with everyone who gets, gives or pays for care.  There are a range of concrete policy options that can foster better measurement – which is the foundation for all efforts to improve the value of our health care system:  1) The recommendations of over 170 groups through Stand for Quality, representing an array of consumers, employers, providers, health plans and more, call for the development of robust, independent systems for collecting and reporting performance results on outcomes, cost and patient experience, 2) Expand comparative effectiveness research that will assure that decisions about care are driven by the evidence and what is in the patient’s interest, and 3) Make available the Medicare claims database to qualified “Quality Reporting Organizations” via HIPAA-compliant agreements.  This would enable employer-sponsored and individually sponsored health benefits plans to use aggregated public and private claims data to generate provider-specific health care performance results and ultimately lower premiums and raise quality of care.

Health care is an information-dependent industry that has failed to keep up with the revolution in knowledge and information processing that has transformed the global economy.  The goals of health IT investments are to improve health care quality and affordability, stimulate innovation, and protect privacy.  These goals can be achieved only through the effective use of information to support better decision-making and more effective processes that improve health outcomes and reduce unnecessary costs.  The definition of “meaningful use” should hinge on whether information is being used to deliver care and support processes that improve patient health status and outcomes.  Consumers, patients, and their families should benefit from health IT through improved access to personal health information without sacrificing their privacy.

The health care system pays providers for the number of treatments and procedures they provide and pays more for using expensive technology or surgical interventions.  Recently a coalition of consumers, employers, labor and providers have come together to support six core principles defined by the Center for Payment Reform:

  • Reward the delivery of quality, cost-effective and affordable care;
  • Encourage and reward patient-centered care that coordinates services across the spectrum of health care providers and care settings;
  • Foster alignment between public and private health care sectors;
  • Make decisions about payment using independent processes;
  • Reduce expenditures on administrative and other processes, and
  • Balance urgency to implement changes against the need to have realistic goals and timelines.

Health care consumers need valid information to compare the quality and cost-efficiency of medical treatments and providers.  Medicare should provide beneficiaries with tools and incentives to make better choices by supporting shared decision making processes.  This support can take the form of both providing incentives to patients to get coaching and reducing payments to providers in cases where preference-sensitive care was delivered in the absence of patient participation in decision-making.

Congress should assure that patient-centeredness and value are at the core of all the decisions made on an ongoing basis.  Policies must be made and revised in ways the incorporate the perspectives of those who receive and pay for care, as well as those who provide care.  Consumers must have the performance information and incentives to make the best choices; and providers must be given the tools to improve and be rewarded for doing a better job.

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Jenny Hu
Policy Analyst
Consumer-Purchaser Alliance

Email: jhu@pbgh.org
Tel: 415-615-6358