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HEALTH REFORM: Appraising Senate Finance's Delivery System Proposals

Senators Baucus and Grassley and the members and staff of the Finance Committee are once again leading the way to a more sustainable health system. With the release of their delivery system policy options, the Finance Committee laid out a vision that will move Medicare and the system as a whole toward paying for value. The document includes many exciting policy ideas and provides an opportunity for the Finance Committee to build on its work to make sure we all receive quality care at lower costs. All ideas are worth a careful read. Upon my first look, I noticed the following:

  1. The effort conveys seriousness of purpose in a bipartisan way. Senators Grassley and Baucus produced this set of options together. Given the partisan rancor exaggerated and unleashed since the election, this is a very good sign for the prospects of sustainable health reform this year.
  2. The vision is comprehensive. There is a genuine commitment to link payment to quality, not volume, for all providers in the Medicare program. The document promotes payment reforms that align incentives across multiple providers so that efficiencies and high quality care are mutually beneficial. Finally, the Finance Committee recognizes the importance of investing in infrastructure, including: HIT, comparative effectiveness research and dissemination, and workforce planning and development. 
  3. There are new and creative ideas. A large portion of the money spent on health care goes toward treating chronic diseases. The Finance Committee outlines a Chronic Care Management Innovation Center. This Center would be empowered to develop payment reform pilots focused on the treatment of chronic diseases that could then be implemented nationwide relatively quickly under the Secretary's authority. The Center would allow appropriate amounts of variation and flexibility to encourage innovation.  
  4. Congress can and must do more. The overall set of policy options, while moving in the right direction, could be strengthened with supplemental policies and stronger incentives to encourage adoption of best practices, improve quality, and lower cost growth. (Expect more from Health CEOs for Health Reform very soon on this front). Achieving a sustainable Medicare program and expanding coverage for the under-65 population will require an upfront investment. Given the inherent political limitations on taxation, we should expect the Finance Committee and other Congressional leaders to build on their recent work and examine additional bold and creative ways to improve value in the Medicare program. Medicare can and should lead system-wide changes to our health system. By providing concrete examples and proof that improvements are possible, the Medicare program can help drive broader health system reform. The Finance Committee and other policymaker should build on their current work and strengthen the incentives for high-quality, efficient care in our health system.