This Bending the Curve report from the Engelberg Center for Health Care Reform at the Brookings Institution, the third in a series, explores what can be done to close “major gaps in the quality and efficiency of health care.”

The authors suggest reforms that could save an estimated $300 billion or more in federal dollars over the next decade.

We propose a framework for reform that focuses on supporting person-centered care. With continued innovation toward more personalized care, this is the best way to improve care and health while also bending the curve of health care cost growth."

RECOMMENDATIONS

Reforms for Medicare:

• Transition to Medicare Comprehensive Care (MCC), which reimburses providers on a capitated basis and requires quality and performance measures be met for full payment.
• Reform Medicare benefits to support more comprehensive care and lower costs.
• Reform Medicare Advantage to promote high value health plan competition.
• Use Medicare savings to create predictable payments in traditional Medicare and support the transition to MCC.

Reforms for Medicaid and Care for Vulnerable Populations:

• Transition current state Medicaid waivers to person-focused Medicaid, a standard process for states to implement Medicaid reforms.
• Medicaid reforms would be aligned with other initiatives and financial support for health care for lower-income individuals to facilitate care continuity and improve efficiency.
• Centers for Medicare and Medicaid Services (CMS) would make permanent and expand its “Financial Alignment Demonstration” for Medicare-Medicaid Enrollees into a reformed program for Medicare-Medicaid Aligned Care.

Reforms for Private Health Insurance Markets and Coverage:

• Limit the exclusion of employer-provided health insurance benefits from income by imposing a cap that is tied to the rate of federal subsidies in Medicare and the insurance marketplaces.
• Encourage and support employers to drive innovative reforms in health care coverage and delivery.
• Promote insurance market competition that encourages lower-cost, innovative health plans, and that provides appropriate incentives for state regulation.
• Facilitate stable non-group and small-group health insurance markets by taking steps to reduce adverse selection and encourage broad participation for more affordable insurance

Still other reforms recommended call for administrative changes to: support higher-value care; improve cost and quality transparency; promote effective antitrust enforcement; promote more efficient state medical liability systems; address outdated licensing barriers; and encourage states to implement system wide reforms.

The Engelberg Center's mission is to develop data-driven, practical policy solutions and recommendations that promote broad access to high-quality, affordable, and innovative care in the United States.