Health Policy

The very recent attention to cost containment through value-based purchasing in the health care reform debate is an encouraging development from NBCH’s perspective. NBCH offers the following five recommendations to the Obama Administration, which support the pillars of value based purchasing:

Standardized Measurement:

• Require the DHHS Secretary to dramatically expand DHHS programs to measure the cost and quality of medical care at all levels.
• Enhance the size and scope of comparative effectiveness research.
• Require DHHS to work with and help fund quality experts in the private sector, coordinated through the National Quality Forum, to develop and endorse provider performance measures and population health measures.
• Allow CMS to publicly release de-identified Medicare data to facilitate all-payer analysis of provider performance.

Public Reporting:

• Require DHHS to develop the systems to collect performance information, in concert with private payers, and publicly report cost and quality profiles for all providers together with population health rankings by state, regions, and local communities.

Payment Reform:

• Require DHHS to transition from the existing fee-for-service reimbursement system to provider payment designs that focus on delivering high value care while emphasizing prevention, primary care, chronic care management and transitions in care. To achieve this goal, DHHS needs stronger authority and the flexibility to support testing, evaluation, changes to payment models in Medicare and Medicaid as well as the ability to align and participate in innovative payment strategies in the private sector.

Consumer Engagement:

• Permit participating plans in health insurance exchange programs, Medicare and Medicaid to modify consumer and beneficiary incentives through premium contributions and copayments to encourage the use of services that promote health and value and to select high performance providers.
• Provide tax credits to employers that implement worksite health and wellness programs and amend the HIPAA regulations that limit the economic value of potential employee incentives for improving health status.

Cost Containment:

• Create a fail-safe mechanism to guarantee health care cost containment.
• Establish and grant the necessary statutory authority to an independent entity of health care experts, separated from Congress, to require implementation of evidence-based cost containment strategies if overall health care spending exceeds wage and cost of living trends.