Monday, November 24, 2008

Insights on the Prospects for Healthcare Reform from the DMAA

Today the Disease Management Care Blog heard former U.S. Senator Breaux of Louisiana and former HCFA Administrator Gail Wilensky talk about the prognosis for health care reform.

Senator Breaux belongs to the ‘too much other stuff to do this year and fundamental health care reform is too complicated camp.’ He predicted Congress will go for the low hanging fruit with funding for SCHIP, information technology, comparative effectiveness and physician payment reform. He thinks Obama-esque reform will take two years - at least.

Dr. Wilensky belongs to the ‘I was unable to sleep and had an 'aha!' moment 2 weeks ago’ camp. Her insight was that the public is concerned about one thing and one thing only: health care affordability. In the meantime, policy makers, politicians and wonks are worried about quality, safety, economic sustainability and entitlements. While they correctly note these issues ultimately drive affordability, Dr. Wilensky predicts the public will have little patience for these high falutin concepts and look for understandable solutions that directly lead to lower costs for insurance and/or health care. This mind-set may be the secret weapon for those opposed to health care reform: Harry and Louise aren’t going to fret over loss of choice, but over rising of cost.

While Dr. Wlensky also agreed that quick reform was unlikely, she pointed out that care coordination and disease management were areas that are benefitting from strong bipartisan support. She felt the future was bright for DM industry.

And before the DMCB had a chance to ask her about it during th Q&A, the topic of bundled payments came up. She likes the idea, because 'ala carte,' fragmented fee-for-service Medicare is one of the biggest drivers of increased utilization. Bundling, in her economist point of view, is a good fix.

Last but not least, the topic of an independent national health board came up. As noted in prior DMCB posts, this may be the most controversial feature of the Democratic reform package. Senator Breaux said the idea has legs not because the U.S. Congress enjoys giving up power, but because there is an emerging consensus among his former colleagues that the Congress can no long micromanage the increasingly complicated details of Medicare and Medicaid.

Tomorrow: a plenary session in which leaders from the health insurance industry, disease management and an integrated delivery system will talk about the prospect of closer coordination between the medical home and disease management. Your intrepid DMCB reporter will be there.

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