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Thursday, March 26, 2015

How a New Cross-Health Sector Network Can Transform the Health Care System

Joseph Ditré

Director of Enterprise and Innovation

New opportunities for consumer advocates to shape the health care system 

Yesterday, President Obama and Department of Health and Human Services Secretary Burwell kicked off the Health Care Payment Learning and Action Network (Network), a network of cross-sector stakeholders focused on quality and costs in the health care system. The network aims to transform our entire health care system—beyond Medicare and Medicaid—from a system that pays for volume to one that pays for quality and value and that actively engages consumers in their own care. More than 2,800 payers, providers, employers, and consumer groups (including Families USA) have registered to participate in the Network.

The kickoff of the Network follows HHS’ bold initiative, announced earlier this year, to transition 30 percent of Medicare payments to alternative payment models that pay for quality—not quantity—by 2016, and 50 percent by 2018. This is important because large providers and private payers are now moving in the same direction. 

As Drew Altman, CEO of the Kaiser Family Foundation, said at the launch of the Peterson Center on Healthcare, “When Medicare sneezes, other payers catch a cold.”

A better, smarter, healthier health care system

Medicare has already put these alternative payment models to work in pilot initiatives around the U.S. According to HHS, these models have contributed to 50,000 fewer patient deaths in hospitals due to avoidable harms (such as infections or medication errors) between 2010 and 2013, and 150,000 fewer preventable hospital readmissions, a decrease of nearly 8 percent, between January 2012 and December 2013. Other similar initiatives through the Partnership for Patients and the Strong Start for Mothers and Newborns helped decrease early elective deliveries by almost 65 percent nationwide between 2010 and 2013, which improved birth outcomes and resulted in fewer at-risk newborns.

Why consumers and advocates need to participate in the Health Care Payment Learning and Action Network

The Affordable Care Act will provide 11.7 million Americans with affordable health coverage in 2015. While more remains to be done to enroll uninsured people in subsidized health coverage, we must now begin to focus as a society on the problems of unsustainable growth in health spending, as well as on spending on unnecessary, duplicative, ineffective, or harmful care. Consumer participation is critical to helping design systems that address the values and needs of consumers and build on their trust. Doing so can create a positive environment for higher quality and lower costs, which can help avoid a backlash similar to the one that occurred in the mid-1990s in reaction to managed care.

How a New Cross-Health Sector Network Can Transform the Health Care System | Families USA


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