This framework for health care reform from the Engelberg Center for Health Care Reform at The Brookings Institution makes proposals for bending the cost curve of health care while making health care delivery more person-centered and personalized.  The bipartisan authors of the framework, which include former Health and Human Services Secretary Donna Shalala, former Centers for Medicare & Medicaid Services Administrators Mark McClellan and Mark Leavitt, former Office of Management & Budget Directors Peter Orszag and Alice Rivlin, and former U.S. Senate Majority Leader Tom Daschle, estimate that the proposals would achieve $300 billion in net federal savings over the next ten years, and long-term net savings of over $1 trillion over the next twenty years.  This project was funded by the Robert Wood Johnson Foundation and the Irene Diamond Fund.

The proposals for reform include:

Reforms for Medicare

  • Transition to “Medicare Comprehensive Care” (global capitated, comprehensive payments for attributed Medicare beneficiaries, with requirements to meet care quality and outcome performance measures for full payment)
  • Reform Medicare benefits to support more comprehensive beneficiary care and lower costs (out-of-pocket maximums, reforms in co-pays and deductibles, eliminate first dollar Medigap coverage)
  • Reform Medicare Advantage to promote high value health plan competition

Reforms for Medicaid and Care for Vulnerable Populations

  • Create a standard program for person-focused Medicaid, enabling states to implement and track performance of Medicaid reforms that reduce per capita beneficiary cost growth while maintaining or improving quality of care (rather than individually negotiated state waivers), and enhance states’ share of the savings (up to 50%) of these reforms
  • Align Medicaid reforms with other initiatives and financial support for health care for lower-income individuals to facilitate care continuity and improve efficiency (such as participation of Medicaid managed care plans in state insurance marketplaces)
  • Expand and make permanent the CMS Capitated Financial Alignment Demonstration for Medicare-Medicaid enrollees with a strong and systematic ongoing evaluation and support capacity

Reforms for Private Health Insurance Markets and Coverage

  • Limit the exclusion of employer-provided health insurance benefits from taxable income by imposing a cap that would grow at the same per capita rate as federal subsidies in Medicare and/or the marketplaces
  • Encourage and support employer leadership in driving innovative reforms in health care coverage and delivery through the Employment Retirement Income Security Act (ERISA) and other health plan regulations
  • Promote insurance market competition that lowers costs while providing access to valuable services that creates appropriate incentives for states
  • Facilitate stable non-group and small-group health insurance markets in the absence of a strong mandate by minimizing the risk of adverse selection and shoring up the safety net

Reforms for System-Wide Efficiencies

  • Simplify and standardize administrative requirements to support higher-value care
  • Improve cost and quality transparency
  • Promote effective antitrust enforcement
  • Address outdated licensing barriers for more effective and efficient care
  • Encourage states to develop more efficient medical liability systems
  • Enable states to implement system-wide reforms

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