Costs

HEALTH REFORM: Health Leaders Exercising Leadership - Now

Len Nichols — Fri, 12 Jun 2009 14:42:00 -0400

I am heartened to see health reform on the move. Today, Health CEOs for Health Reform will explain exactly why and how we can and should expect health care leaders to work together to make Americans healthier, while bending the health care cost growth curve. A credible roadmap to reduce health care cost growth will help us achieve both bipartisan reform and fiscal balance.

Information on the event (12:30pm, Senate side of the Capitol Visitors Center) is available here and their specific set of recommendations are available here.

Health CEOs for Health Reform leaders are committed to providing everyone—including our most vulnerable—the highest quality most efficient care. They are courageous because they are willing to:

Recognize the importance of patient-centeredness, and emphasize the value in comparative effectiveness research and best practice processes
Explain why fee-for-service payment is unsustainable
Expect providers to be held accountable to reasonable cost and quality standards at a specified date
Support a transition toward more integrated, coordinated models of care that require providers of all types to work together to keep patients healthy
Use Medicare payment reform as the catalyst to transforming incentives system-wide
Identify supporting policy changes to make payment reform more effective

Leadership from the health care community is critical to delivering on the promises of coverage for all, higher quality, and lower costs. Health CEOs for Health Reform prove if we look and learn from our own backyards, we can achieve our goals.

To be sustainable economically and politically over time, legislation must be bipartisan. It is encouraging to see Republicans, Democrats, and stakeholder organizations working together to address the many challenges facing our health system, despite the odds and forces that work against such collaboration.

COVERAGE: Uninsured Shift Costs onto Insured, Families USA Finds

Kyle Noonan — Thu, 28 May 2009 16:17:00 -0400

Families USA has released a report describing the costs to the insured that result from uninsured people who are unable to pay their bills. The report, entitled "Hidden Health Tax: Americans Pay a Premium," analyzes the cost-shift from the unpaid medical bills of the uninsured to those Americans with health insurance.

Key findings of the Families USA report:

The uninsured end up paying over a third of their medical bills out of pocket. Governments and charities pick up another quarter of the cost.
The remaining 37 percent of the cost of the medical bills for the uninsured, or a stunning $42 billion, went unpaid in 2007.
That unpaid portion is passed on by providers to private insurers, who pass the cost on to the insured.

Families USA estimates that the average American family pays over $1,000 a year in higher health insurance premiums due to this cost-shift. (For an individual purchasing in the individual market, it's about $368.)The Center for American Progress found similar figures in a report earlier this year.

This cost-shift has intensified in recent years, the report states, as more people lose their health insurance. Without comprehensive health reform, it's also expected to continue to worsen.

IN THE STATES: Maine’s Cost Drivers: The Same, Only More So

Kyle Noonan — Fri, 01 May 2009 14:05:00 -0400

For years, Maine has been unwilling to wait for the federal government to tackle the crisis of health care. And with good reason: though Maine has one of the lowest rates of uninsurance, it has some of the most expensive health care in the country. One-third of the state budget goes to SCHIP/Medicaid (the highest rate in the country, the state has the highest employer contribution to the cost of employer-based insurance, and the third-highest per capita health care costs. Not surprisingly, the cost drivers that make Maine's health care so expensive are the same as those that afflict the national as a whole, according to a new report by a state advisory group.

In 2003, the Maine Legislature passed far-reaching legislation to tackle coverage and costs—including the creation of the Dirigo Health insurance program—that included aggressive collection of data that had not previously been available. Maine's Advisory Council on Health Systems Development outlined problems and proposed solutions that will look familiar to those who've followed the health reform debate at the national level.

First, the council crunched the numbers on utilization based on public and private claims data. Essentially, Maine created a smaller scale Dartmouth Atlas. They found huge and unwarranted variability across the state's 24 "hospital utilization areas" in both private and public health insurance. Many of the state's inpatient hospitalization dollars are wasted.

Second, the council proposed moving toward "evidence-based benefit design." This is a recognition that fee-for-service provides no incentive for better medicine, just more medicine, and that incentives are needed to dampen demand for those services that add little value. The council suggests tiering providers based on value metrics from cost and quality data—an ambitious and controversial but worthy project.

Maine also has emergency room utilization rates 30 percent higher than the New England average. Though the report noted that emergency rooms are not a significant portion of Maine's health care costs, high emergency room use means long waits and fragmented care.

There are a couple of lessons here. First, without the huge amount of data that Maine gathered from claims to public and private insurers, much of the analysis would be impossible. We hope that the health IT provisions of the economic stimulus law will make new population-level data available and facilitate more of this kind of analysis. Next, to reduce utilization of health resources that don't improve health, we need to change the incentives. If the incentives are for more utilization, you get more utilization. If we create incentives for smarter utilization, we'll get smarter utilization. We vote for smarter.

IN THE NEWS: OMG! OMB! Orszag on the Daily Show

Paul Testa — Fri, 03 Apr 2009 17:11:00 -0400

In case you missed it, OMB director Peter Orszag was on the Daily Show Wednesday. The man who’s “made nerdy sexy” according to Rahm Emanuel, was on his game, had one thing on his mind: health care.

One of the reasons we need to get health care costs under control is because that is the key thing that is forcing us to borrow as you go out five, 10, 15 years. That’s why the President wants to get health care reform done this year because it brings down costs overt time. … The banking crisis is crucial to what’s happening this year, but as you go out over time, the thing that’s driving our fiscal future is the rate at which health cares costs are growing.

Part I below, part II after the break.

The Daily Show With Jon Stewart

M - Th 11p / 10c

Peter Orszag Pt. 1

comedycentral.com

Daily Show Full Episodes

Economic Crisis

Political Humor

Part II