Wednesday, April 23, 2008

The Top Three Approaches to Health Care Reform from Three Points of View

So here’s something that sounds like an old joke: a businessman, a physician and an economist walk onto a wired-for-sound dais and are asked to list their top three elements for health care reform. From an afternoon session of the April 22 World Health Care Congress:

Webber of the National Business Coalition on Health:

Payment Reform: stop paying for volumes of units, pay less for specialty care, more for primary care, go with pay for performance, increase the role of market forces, decrease fee for service and increase bundling.

Consumer Activation: leverage this and help them choose high performing options

Total Quality Management: promote process engineering, technology, metrics and tracking.

Tooker of the American College of Physicians:

Primary Care Base: it needs to be strengthened with the Patient Centered Medical Home

Patients First: to do this, adopt the primary care physicians’ proposal for the Patient Centered Medical Home.

Financing Reform: uncouple physicians from financial incentives that lead physicians to do more by paying for the Patient Centered Medical Home.

Reinhardt of Princeton:

Health Information Technology: Data is already retrievable on every doc’s orders, which means payors and purchasers already have the resources to compare physicians and hold them accountable.

Comparative Effectiveness: And don’t let the U.S. government ‘house’ this. Rather, use an endowment mechanism to set up one or more independent entities that use open source data. The market will know what to do with its non-binding insights.

Payment Reform: bundle payments by paying per treatment episode, and be willing to include health (not just sickness) management as well as sticks and carrots that incent the right kind of patient behaviors.

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