Monday, March 22, 2010

The House Passes Health Reform: What Does It REALLY Say about Prevention?

The Disease Management Care Blog watched last night's speechifying that accompanied the House's health reform and was struck by Speaker Pelosi's repeating the 'prevention' refrain:

"...the list goes on and on about the health care reforms that are in this legislation: insure 32 million more people... end insurance company discrimination .....creating a healthier America through prevention, through wellness and innovation, create 4 million jobs in the life of the bill and doing all of that by saving the taxpayer $1.3 trillion dollars" (bolding from the DMCB).

Which begs the question: now that reform is at hand, will our new and improved health insurance system now pay for preventive care?

To find out, the trusting but verifying DMCB blew tanks, dove through the House's legislative language posted here and uncovered this quote:

The CMS Administrator would conduct an assessment of the diseases and conditions that are the most cost-intensive for the Medicare program. The assessment would inform research priorities within HHS in order to improve the prevention, or treatment or cure, of such diseases and conditions. Not later than January 1, 2011, the Administrator would submit the report to the Secretary of Health and Human Services and the Secretary would transmit the report to the Congress.

So, a more more accurate interpretation of the legislation that was passed by the House may be that it would create prevention research for a healthier America.

But then the DMCB paddled back to the Senate's language and looked for more. It found that that creates an Independent Medicare Advisory Board that is charged with making cost-saving recommendations that promote prevention, a National Prevention Health Promotion and Public Health Council to coordinate prevention, a Preventive Services Task Force to make recommendations about prevention, a national private-public partnership to raise awareness about prevention and a web site on prevention. In addition, there are provisions for research grants and contracts that fund health teams so that they can counsel patients about prevention, grants to States to test prevention programs in Medicaid as well as fund community programs, offers of technical assistance to employers for wellness programs and establishment of a "Prevention and Public Health Fund" that would invest in prevention and public health programs. Last but not least, Medicare would cover an annual visit that creates a "personalized prevention plan."

So, a really really more accurate description of this legislative bundle is that it would fund research, contracts, assistance and grants on prevention, create various bureaucracies devoted to prevention and include coverage for provider visits devoted to counseling about prevention.

As its prior posts may indicate, the DMCB has been skeptical about Feds' ability to deliver on their health reform promises. However, 1) it's now the law of the land, 2) all still remains right with the universe because the Orange are hanging in there and 3) some solace was within reach yesterday thanks to this mixed with a version of this. Who knows, maybe some good will come of reform, especially if some of the folks running things in DC read this blog once in a while.

In the meantime, it appears to the DMCB that the short answer to the question at the beginning of this post is that, outside of lots of Federal largesse and bureaucracies, the health insurance system will now cover provider counseling on prevention for consumers. In tomorrow's post, we'll examine in greater detail whether that is really as wonderful as Ms. Pelosi's speech implied.


Phil 314 said...

Have they ever thought of consulting their own task force, the US Preventative Services Task Force.

I mean, why re-invent the wheel.

Jaan Sidorov said...

In the subsequent prevention posts, I point out the role of the USPSTF. If I'm reading the legislation correctly, insurers will be required to cover their A and B recommendations; however, the converse is NOT true. If the Task Forces DOESN'T endorse something, that doesn't mean insurers can't cover it - an infamous example being mammograms for women < 40 years.

Thanks c3!