Delivery system reform is the Ray Romano of issues for proponents of health reform: Everybody loves it. On both sides of the aisle, there is a strong agreement belief that comprehensive health reform can and must improve quality while reducing costs.

That bipartisan consensus was on display Tuesday at the Senate Finance Committee's roundtable discussion on "Reforming America's Health Care Delivery System." The hearing brought together key members of Congress with experts and stakeholders for an insightful discussion of the actual steps we can take to transform the way we deliver health care in this country. The discussion wasn't all theoretical either; participants could point to things that we know work.

The full three-hour video of the roundtable is available here, and you can catch our play-by-play of the discussion on Twitter (tag #SenFin). Freed from our 140-character constraints, we'd like to elaborate on a few of the common themes and important points made during hearing.

Increasing quality can decrease the cost of care

Dr. Glenn Steele, president and CEO of Geisinger Health System made this point abundantly clear describing some GHS efforts to redesign the way it delivers care. He described how the organization's patient-centered medical home, with its focus on reducing variations in care and better management of chronic diseases, was able to reduce hospital admissions by 25 percent and readmissions by more than half. As an integrated system that matches a health plan with a network of providers and hospitals-GHS can return the savings of higher quality care to the consumer in the form of lower premiums.(We've blogged about Geisinger in the past, and the AARP Bulletin recently profiled some of its innovations). 

Realign Incentives

Of course not all patients receive care in integrated system like Geisinger that can share savings between providers, patients, and payers. In fact, the vast majority of care is delivered in smaller less integrated provider groups. Participants in the roundtable agreed a  variety of approaches were needed to reflect the variety of ways care is delivered. Mark B. McClellan, of the Brookings Institute, spoke about the need reward innovation while promoting accountability. As McClellan noted, too often fee-for-service medicine prevents doctors from spending the time needed with their patients.  Glenn M. Hackbarth,  of MedPAC, reiterated his organization's previous calls for changes to the way we pay for primary care. Sen. Maria Cantwell, a Washington Democrat, stressed, "People are using the emergency room as their primary care physician and it's costing us."  As many participants noted an emphasis on primary care while also require an investment in our primary care workforce.

Focus on patients and the areas of greatest need:

As we've noted before, Willie Sutton robbed banks because that's where the money was. Many of the participants much of our health care spending is concentrated in relatively small percent of the population-patients with multiple chronic diseases or in the final stages of life. Focusing on high cost areas, like diabetes or hypertension  has the potential to produce real savings. Mary D. Naylor, a professor at UPenn's School of Nursing, described her work with a transitional care model that takes a team based approach to coordinating the care for older Americans with multiple chronic conditions. The programs shown real savings-an average of $5,000 per Medicare beneficiary. (We've also blogged about the Penn program in the past.)

Medicare and Medicaid can help drive reforms, but changes must be made to CMS

Steele suggested CMS, the agency that runs Medicare and Medicaid, should be "transformed into an engine of innovation." But as both Steele and others noted there were barriers both internally and politically. One suggestion was to improve the demonstration process to shorten the cycle between innovation and adoption. For one ways to improve Medicare check out New America's project on ways to make Medicare a value-based purchaser.