Comprehensive health care reform appears to have stalled at the federal level. However, this does not mean that nothing can move forward. There are the options that should be considered.
In preparing its recommendation to the Colorado General Assembly, Colorado’s Blue Ribbon Commission for Health Care Reform understood that putting more people into an inefficient system would raise costs. The commission thought that if the revisions needed for improving efficiency were implemented first, then the actual savings that would result could be used to pay for the expansion of desired eligibility and enrollment aspects of health care reform.
A preliminary listing of reform priorities:
• Focus actions on cost containment, quality improvement, and improved efficiency before coverage expansion is considered.
• Provide the revised MEDPAC agency with the ability to set provider reimbursement rates for Medicare and Medicaid, without the approval of Congress.
• Expand the authority of the current MEDPAC Agency to enable it to evaluate and implement changes to the Medicare and Medicaid programs related to physician and hospital reimbursement.
These changes would then improve the efficiency of the current medical delivery system and thus reduce cost. Examples would include:
• A prospective payment system methodology that would provide significant differential payments for those primary care providers utilizing medical homes to serve patients and demonstrating improved outcomes and/or cost effectiveness;
• A global payment methodology for Accountable Payment Organizations;
• Setting differential payments for communities in Medicare and Medicaid based not on cost of living indices, but on cost-effective improvements to the care delivery system, such as reducing hospital readmissions or emergency room utilizations;
• Setting specific cost targets for Medicare and Medicaid that would adjust over time so the impact of medical inflation can be controlled;
• Provide federal protection/limited liability exposure for physicians who follow established medical protocols;
• Ensure the payment system includes meaningful rewards for health care providers who attain established medical quality benchmarks;
• Provide differential Medicare and Medicaid payments as incentives for the expansion of electronic medical records (EMR) and interoperability requirements between systems with EMR capabilities;
• Retain some aspects of the anti-trust exemption for insurers, but limit these opportunities to:
• Creation of a uniform health plan identification to enhance the accuracy of plan information provided on the card;
• Creation of uniform processes and procedures used for credentialing providers and the protocols for disease and case management;
• Development of enhanced electronic claims processing, interoperable claim data and a nationwide all-payer data base;
• Creation of a uniform process for filing claims, verifying eligibility for participants;
• Creation of a uniform, electronic and telephonic system for participants’ service support;
• Developing a plan to move toward a uniform reimbursement plan for all payers (Medicare, Medicaid, CHP, and commercial insurance);
• Clarify and revise the current anti-trust rules to promote efforts by independent health care providers who desire to collaborate on efforts to promote quality outcomes, and sharing information on clinical quality;
• Develop funding sources to assist the states fund efforts to address nurse and primary physician shortages that exist across the country;
• Increase Medicaid reimbursement to 100 percent of Medicare over time, as savings emerge; and
• Significantly increase Medicare/Medicaid fraud and abuse enforcement.
Some will argue that the public is clamoring for insurance reform as a key component of any health care reform. However, comprehensive reform (insurance reform and cost containment) is not fiscally realistic at this time. Yet, we also cannot afford to walk away from the entire subject.
Bill Lindsay is president of the Benefit Group for Lockton Companies and was chair of the Colorado Blue Ribbon Com- mission for Health Care Reform.
