Delivery System Day: Chris Jennings
Chris Jennings served as a senior health care adviser to the White House from 1993 to 2000. He wasn't quite a czar, but close. And so he is particularly sensitive to the political structuring of some of this stuff.
You will hear ad nauseam about Accountable Care Organizations (ACOs) and Comparative Effectiveness Research (CER) and their respective interaction with a modernized infrastructure (helped to be created by HIT). All are important and should be highlighted, but I figure you will get this from multiple sources.
Instead, I choose to focus on a couple of other diamonds in the rough. The first would be the funding for prioritization and development of quality measures linked to aggressive reimbursement incentives to physicians for reporting on these measures. (These measures, developed by health professionals, are used to promote best practices for some of the most expensive chronic diseases, such as heart disease, cancer and diabetes). I have concluded that we will never really change the way we deliver health care without the buy-in of the medical profession, which can only be secured if they develop and apply measures that can be used to empower practitioners and hold them accountable through comparative outcomes with/by their peers.
A second, and related issue, is a Finance Committee provision which gives CMS the authority to develop pilot programs to test methods of reimbursing providers for chronic disease management, (including collaborations with the states and the dual eligible program). Today, the easiest course of medical intervention is to prescribe treatment plans that deal with the effects of the disease, high cholesterol, high blood pressure, etc., rather than spending time with patients to help motivate them to take control of their health and manage their own diseases through lifestyle changes. Only when patients begin to understand that they must be the focal point of any intervention to constrain or even reverse the course of expensive chronic illness and, ultimately, produce savings, will we have made progress. The most creative part of this policy is to allow the pilots to be constructed in a fashion that waive strict budget neutrality requirements (because this has killed ideas in the past) AND allows them to expand nationally automatically (without any other legislative action) IF they can prove budget neutrality or better in the budget window. We all know that chronic illness is the primary contributor to our nation’s health-care tab – preventing and managing it is one of the absolute keys in getting the ultimate job done.
That last bit on automatic expansion is something I hadn't heard before. But it makes a lot of sense.
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