Where Now On Health Reform? Expert Perspectives

mcclellan_markFollowing Senator-elect Scott Brown’s victory in Massachusetts Tuesday night, there is no consensus yet in Washington as to what happens next on health reform.  Opinions fall into a wide spectrum, from encouraging the House to pass the Senate bill as is to abandoning the effort altogether.

As I’ve said publicly and in an earlier post on this blog, I believe the Massachusetts outcome presents an opportunity for the congressional leadership to re-evaluate its direction on health reform, understand why it’s failing to gain public support, and develop a new bill that focuses on the essential elements of reform Americans and our healthcare system need.  We need to fix health reform, not kill it.

Toward that end, it would be wise to solicit the opinions of those who have real expertise on the subject.  Former Centers for Medicare and Medicaid Services administrator Dr. Mark McClellan had an insightful op-ed piece in yesterday’s Wall Street Journal that should not escape notice.

Dr. McClellan expands upon a criticism we’ve made at HLC regarding the bills passed by both the Senate and House.  They don’t go far enough in the areas of delivery and payment reform – critical elements that health reform must include if we are to move toward a system that pays for value instead of volume of services.  Dr. McClellan wrote:

“No one knows how to implement in a timely manner the long list of proposed pilots that might contribute to improving care and reducing costs on a national scale. While the proposed legislation does allow for providers to share in the savings of reform, it does so only in pilots that in Medicare’s experience can take a decade to set up, implement and evaluate, and that still don’t lead to replicable results. Consequently, it is far from clear that the reform bill will transform the health-care system without compromising quality.”

Dr. McClellan is correct. The federal government doesn’t have a strong track record of timely transformation of pilot projects into real-world programs and policies.  We’ve already seen successful, innovative approaches by organizations like the Marshfield Clinic and Premier in CMS demonstration projects, in which they’ve shown that costs can be contained while still providing high-quality healthcare.  We need to use those results we already have in hand to build workable delivery reforms.

The McClellan op-ed also addresses important issues like using health information technology to delivery critical information to clinicians in real time and encouraging healthy behavior by patients through health insurance premium incentives.

It’s an op-ed well worth reading and the kind of expertise we need as we try to get health reform back on track.