Managing the Cost of Health Care for America: Ensuring Quality, Value and Access (Commentary by Steve Abell: Benefiting Arkansas)

by By Steve Abell  on Monday, May. 5, 2008 12:00 am  

(To view a graphic depicting the national health expenditures by source of funds for the past five years, click here.) 

It's broken. Let's fix it. Together. Health care in America is highly fragmented, not operating as a true health care system. The statistics are staggering.

  • Only about half the patients - 55 percent according to a RAND study - get the recommended course of evidence-based care, which means the other 45 percent do not.
  • The cost of health care to our nation and our economy is tremendous. We devote a far greater percentage of our national spending to health care than does any other country - 16.2 percent of our GDP, according to the World Health Organization. That equates to more than $7,000 for every man, woman and child in America.

Our current health care system is further challenged by the fact that 47 million people are uninsured, 10 million of them children.

Escalating costs make it hard for those without coverage to obtain it - and the 85 percent of Americans who do have insurance fear they could lose their coverage because of rising costs.

We know Americans without the benefit of health insurance get sicker and die sooner than those with coverage. We also know that rising health care costs have made coverage unaffordable for many.

Health insurers, particularly the Blue Cross & Blue Shield system of plans, strongly believe that everyone in America should have access to affordable health care. However, a health care system that is unaffordable for many today will not work for tomorrow.

Traditionally, health plans have focused on network discounts to try to hold the line on cost. However, today's fee-for-service system lacks the proper incentives to promote the most cost-effective care while assuring the highest quality.

We must make addressing both rising health care costs and assuring access to affordable health care for everyone a national priority.

Achieving better value and improved access to quality health care is possible by building on our current employer-based system with five key initiatives:

1. Encourage Research on What Works

  • Health plans - and the employers they represent - want to pay for what works. We must encourage research on what works and provide this information to both consumers and providers of care. Blue Plans are supporting this initiative through the Technology Evaluation Center, which evaluates the effectiveness of drugs, medical devices, procedures and biologics using independent experts and scientific criteria to help inform coverage decisions and give providers information on what works best.
  • America needs an independent institute to support research comparing the relative effectiveness of new and existing medical procedures, drugs, devices and biologics. To ensure that providers have information on what works best, the government should create an independent comparative effectiveness research institute, insulated from political pressures and funded by all payers - public and private. This institute would respond to the needs of frontline providers, giving them timely information to make the best care decisions. The institute should support a broad range of research: clinical trials, cohort studies and literature reviews. The goal is not to duplicate other efforts, but rather to fill gaps and expand the universe of research already being done.

2. Change Incentives to Promote Better Care

  • The incentives in our system must be changed to advance the best possible care. Today, providers are paid for volume, a fee for each medical service performed. Rising malpractice premiums are fueling the practice of defensive medicine, increasing the use of unnecessary health care services. We must change the incentives to reward providers for delivering high-quality, evidence-based care, especially for the increasing number of Americans with chronic conditions. Government-funded programs, like Medicare, are a good place to start.
  • Blue Cross & Blue Shield plans are working to promote high-quality care through a number of initiatives, including the Blue Distinction Centers of Excellence program. It recognizes, and steers patients to, those facilities that have demonstrated excellence in patient care.

3. Empower Consumers and Providers



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