Knowing how busy readers are, the DMCB has created this even shorter cliff notes summary of the Health Affairs cliff notes. The DMCB also found and includes some other nuggets of interest:
- It’s the costs of health care, not the lack of insurance coverage.
- Change Medicare and everything else follows. Medicare leads the way.
- Elimination of waste and inefficiency should take precedence over tax increases.
- The path is clear: a) value-based purchasing in lieu of fee for service, b) physician accountability in lieu of routine payment, c) Congressional oversight and evidence-based coverage in lieu of micromanagement and wide physician leeway and finally d) driving a coherent policy in lieu of dealing with multiple agendas.
- Value based purchasing is the use of multiple tools that lead to the right kind and mix of services, of desired quality, at a reasonable cost based on the total population’s needs instead of individual interventions aimed at individual diseases. Nugget: there is precious little in the original Medicare statute that prohibits value based purchasing. Rather, regulations that promote it have never been successfully promulgated.
- In order for Medicare to take advantage of value based purchasing, it will need to be reformed.
- One ingredient for reform: creation of a new “entity” that is insulated from day to day lobbying. It can free Medicare to strategically and tactically pursue value based purchasing with integrity and the public’s confidence.
- Persons in the new entity are “Guardians” and they decide which coverage and pricing can be made by CMS and which can be made by Congress. Guardians are subject to Senate confirmation and have term limits. Nugget: Guardians” are selfless stewards of government modeled after Plato’s Republic.
- And finally the original report points out that value based purchasing can include traditional disease management.