Tuesday, November 11, 2008

The DMCB's Principles for Healthcare Reform

Exciting times indeed. The new President is setting up his cabinet while the Congress is readying itself for the new legislative session. The economy is job one, but a majority of those who elected Obama expect something big from our new President in the health care arena. Is the time right for a complete overhaul of the healthcare system, or should we pursue incremental reform?

Either way, change is in the air. One symptom of this is the number of organizations that are offering up recommendations or principles for reform.

The DMCB has been thinking about this for several days. After seeing the band 'Yes' in concert and seeing how Steve Howe's still got the chops tonight, it decided to post some of its own principles. It thinks they're best read by clicking below on the 2nd part of Starship Trooper and letting it play in the background. Hope your speakers have sufficient bass:

The rising cost of health care is our most pressing challenge. Failure to control costs will inevitably lead to rationing. Imperfect but useful options to slow the rate of cost increases include, but are not limited to, prior authorization, value-based purchasing, increased consumer participation in the purchase of transparently priced health care services and bundled payment arrangements.

Chronic illness is a significant source of health care's cost increases. Imperfect options to slow the rate of increase and achieve greater value include, but are not limited to, disease management, the chronic care model, pay for performance, consumer incentives, decision support, patient registries and electronic records. Combinations work better than any single option.

Health insurance is necessary but not sufficient to assure adequate access to health care. Options to increase participation in health insurance include requiring coverage (play or pay), lowering premium expense by control of cost (see above) plus, over the short term, value-based insurance designs and plans that trade lower premiums for increased out of pocket expenses. Serious consideration should be given to insurance options that protect against financial ruin, not meeting mandates. Increased participation in health insurance is likely to increase utilization of health care.

Stop talking waste, start talking value. Start with assessing how to maximize the effectiveness of studying comparative effectiveness. Assessment of technologies will need to consider their potential of additive growth vs. substitutive value.

Primary care is of sufficient value by itself to warrant increased payment without any need to concoct rationales such as pay for performance or extra payment for patient centered medical homes.

Research funding must be focused on improving systems of care outside Academic Medical Centers or Integrated Delivery Systems. Some funding should be discarded in favor of Prizes. Registries of data from publically funded research should be deidentified and open sourced on-line for data analysis.

The worksite and community are the better locations to provide wellness and prevention programs, not the health care system.

The public schools and community are a better location to provide obesity prevention and management, not the health care system.

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