JAMA Feature: Consensus Growing On Next Steps In Sustainable Health Reform

Posted on | October 9, 2013 | Comments Off on JAMA Feature: Consensus Growing On Next Steps In Sustainable Health Reform

The September 30, 2013 JAMA article, The Elusive Path to Health Care Sustainability by John C. Lewin, MD; G. Lawrence Atkins, PhD; Larry McNeely, MPA reviews various proposals with an eye toward consensus building. They say:

“Most significantly, the proposals reveal broad, if not always unanimous, agreement about how to advance the principles they espouse. This agreement offers the basis for crafting the next steps in reform, which include (1) value-based payment reform (all plans promote shifting from fee-for-service reimbursement for clinicians and hospitals to incentives for improved care quality, patient satisfaction, and measured outcomes); (2) value-based insurance design (all proposals promote incentives [lower co-payments and costs] for patients to choose higher-quality clinicians, hospitals, and treatment options and to demonstrate healthier behaviors and better adherence to effective treatment); (3) efficient administration and markets (a clear majority of the plans would promote administrative efficiency and information technology innovation, selective antitrust relief, reduced medical liability costs, investment in evidence-based benefits and research, and workforce innovation); (4) broader reforms (4 of 7 proposals supported structural reforms to Medicare, such as forming an intermediate option between Medicare and Medicare Advantage and modifications to the tax deductibility of private insurance, intended to promote insurance competition); and (5) overall spending limits (3 of the plans supported spending caps, or spending targets with consequences if exceeded).”