While representing diverse constituencies and perspectives, we strongly believe that unsustainable increases in health care spending urgently call for integrated, system-wide reforms that generate better value."
—Partnership for Sustainable Health Care
Washington, D.C.—Five national organizations representing diverse constituencies involved in the nation’s health care system joined together in presenting consensus recommendations today for improving health care quality while lowering costs nationwide.
Calling itself the Partnership for Sustainable Health Care, the group includes nationally prominent advocates for employers, insurers, consumers, health care providers and others. Participants include America’s Health Insurance Plans, Ascension Health, Families USA, National Coalition on Health Care and Pacific Business Group on Health.
“No single organization working alone, and no single policy approach, will achieve the lower-cost, higher-quality imperative. Moderating health costs while improving quality of care must be an all-hands-on-deck commitment,” said Ron Pollack, executive director of Families USA. “It is high time for us to bend the cost curve and improve patient care by fully engaging the public and private sectors, rather than perpetuating cost shifts among sectors or to consumers.”
The organizations recommend a set of integrated, system-wide approaches involving both the public and private sector that they say will significantly curb the growth in health care spending and enhance the delivery of care. The organizations met regularly for more than a year to develop proposals and were supported in their work with a grant from the Robert Wood Johnson Foundation.
“We believe our health system will generate better value when consumers and providers face aligned incentives—based on evidence of what works—that reward quality care and efficient use of resources,” said David Lansky, president and CEO of the Pacific Business Group on Health. “Our work together shows that representatives of diverse interests can work in the public interest toward a common approach to improving health care.”
The group’s recommendations are five-fold:
- Transform the way health care providers are paid, to emphasize value of services provided, rather than volume. Partnership members believe that private and public insurance programs must transition from the current ‘fee-for-service’ payment system to one that better rewards quality and value. They call on the public and private sectors to implement a range of alternative payment and delivery models over the next five years, in order to quantify results and spread successful models.
- Pay for care that is proven to work. Partnership members recommend a tiered reimbursement strategy that links payment directly to effectiveness. They recommend that both public and private insurers reduce payment for services that prove to be less effective and to have weaker value than alternative therapies.
- Encourage consumers to choose high-quality care. Partnership members recommend incentivizing consumers to select high-performing providers. They point to models like value-based insurance design, which offer financial incentives to consumers—such as reduced cost-sharing—when they opt for evidence-based treatments and obtain care from providers who deliver high-quality care. Traditional Medicare should be modified to allow tiered cost-sharing for beneficiaries who use high-quality providers, and drugs and services that are proven effective.
- Improve the nation’s health care infrastructure. Partnership members recommend reforms aimed at strengthening the foundational infrastructure of America’s health care system so that cost- and quality-related innovations can be implemented more effectively. They call for establishing a uniform and prudent set of quality and other performance measures to be used by both the public and private sectors to support provider payment reform, consumer incentives and healthy competition in health care markets.
- Incentivize states to improve care. Partnership members recommend establishing a gain-sharing program for states, which would encourage innovative approaches to controlling health care costs. States that participate would outline specific savings goals, with defined rewards for meeting them. States that slow the growth of total spending would be rewarded with a percentage of the savings. The recommendations include numerous ways to ensure that cost-reduction is accomplished responsibly and builds upon the access gains achieved through the Affordable Care Act.
“These five ideas are game-changers that can place our health system on a sustainable path. Together, they can provide significant long-term relief for families and businesses facing rising costs and uneven quality,” said John Rother, president and CEO of the National Coalition on Health Care. “By encouraging new forms of health care delivery and spending our health care dollars more wisely, they can produce the real health-cost reform that our elected leaders in Washington have been searching for.”
Leaders of the Partnership believe their comprehensive approach to integrate public and private sector actions toward improving the health system will help stop the ‘silo effects’ of health care, including shifting costs from one partner or sector to another.
“High-value, affordable health care for individuals and families requires a sustained commitment by all stakeholders to actively engage and address the drivers of health costs throughout the system,” said Karen Ignagni, president and CEO of America’s Health Insurance Plans. “Today's report presents an actionable roadmap for reform.”
The leaders say they understand that change will not happen easily or quickly, but believe these recommendations create the opportunity for significant momentum in the immediate future, for system-wide transformation, toward which substantial progress can be achieved in just five years.
“To meet America’s health care needs, with special attention to the poor and vulnerable, we know that health care providers must fundamentally reconfigure delivery systems, care processes and cost structures. Moving to managing the health of defined populations demands recognition and acceptance of the magnitude of the transformational change required,” said Robert Henkel, FACHE, president and CEO of Ascension Health. “The consensus recommendations we present today provide a roadmap to move our country toward an achievable, high-performing, person-centered, coordinated system with lower costs.”
The Partnership organizations plan to continue their work by reaching out to and engaging many other health care stakeholder groups that are also interested in promoting health cost efficiencies while improving quality of care.
See the Partnership for Sustainable Health Care recommendations at www.rwjf.org.
Alexis Levy | Robert Wood Johnson Foundation | firstname.lastname@example.org | (609) 627-5702
About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter www.rwjf.org/twitter or Facebook www.rwjf.org/facebook.
Health care reform may create incentives to spur the growth in HDHPs and CDHPs, a move that might help hold costs down?at least for a time.
“Unreasonable” insurance rate increases will be regulated under the Affordable Care Act, but some states lack the authority to block rate in...
This article examines the theoretical and empirical literature on cost shifting since 1996, synthesizes the predominant findings, suggests t...
Steven A. Schroeder, MD, has devoted his career to reducing excessive health care spending at major medical institutions. In this special he...
Rheumatoid arthritis (RA) affects 1.5 million Americans every year. Early, aggressive treatment of RA incurs high costs this study modeled t...
Obesity is associated with serious health problems, and it can generate adverse economic outcomes.
Victor R. Fuchs studied the factors that affect health care expenditures and health and policy solutions for covering the uninsured and redu...
Report details research conducted to develop and test simple messages that explain the concepts of payment and delivery reform to consumers ...
Report details research conducted to develop and test simple messages that will help local AF4Q leaders begin discussions about payment and ...
The public health financial management workforce lacks the knowledge, skills, and abilities necessary to uphold its professional responsibil...
Benefit design has similar effects on health care use for low- and high-risk patients.
This issue brief examines how income and wealth can shape health.