The status quo in health care is unacceptable – with high and rising costs, inconsistent quality and millions uninsured, we agree that change is essential.  There is growing consensus that changing how we pay for health care must be a central element of reform.  The current fee-for-service model isn’t working, and we have an opportunity to address that problem as we reshape the nation’s health care system. Current proposals include many new models of payment that reward better health care outcomes and foster efficiency.  These models are essential if we are to slow the rate of growth in costs while also improving care.  As the reform debate enters the important window when compromises are being made and potentially final details are being negotiated, it is more important than ever to be sure that any ultimate reform package includes not only substantive payment reform, but also a clear path to harmonize public and private payment policies.

 

Yesterday, the New England Journal of Medicine published an article — Payment Reform: The Need to Harmonize Approaches in Medicare and the Private Sector — co-authored by Dr. John Tooker, CEO of the American College of Physicians, which represents 129,000 internal medicine physicians and students across America, Dr. Robert Berenson, who knows about payment as a senior staff with the CMS’s predecessor, as a practicing physician and as an astute public policy participant, and myself representing both those who pay for and receive health care.  This article was in large part the product of dialogue we and others had at the ABIM Foundation Forum in August of this year and productive follow-up discussions organized by the Foundation.  We are grateful to many for their contributions to the ideas reflected in this article and look forward to continuing this work through the Center for Payment Reform, which brings together consumers, clinicians, employers, labor and more to change payment to reward better value instead of volume. 

 

In this article, we highlight a handful of simple but critically important actions that need to be taken to harmonize payment approaches among public and private purchasers.  These provisions are reflected in the current legislation and in particular in some of the amendments recently proposed by a group of freshmen Democrats in the Senate.  But, as you know, details matter and the process is far from over.

 

Because of that, I encourage you to continue to add your voice to the important issue of not only changing payment to foster delivery reform, but to be sure that these changes align public and private payers.  To that end, you can:

·         Share this information and the NEJM article with your colleagues and others, noting your agreement with the role that payment plays in shaping delivery;

• Communicate to members of the Senate, the House and the Administration your belief in the importance of this alignment and your support for their taking the simple steps reflected in this article; and
• Work with payers outside of Medicare – both other public payers and private plans at the national, state and regional levels – to engage in active partnerships with one another that seek to align their efforts to promote higher value.

 It is critically important that health reform include the alignment of public and private sector payments.  We have a unique opportunity to create a new delivery system and improve the quality and value of health care in America.

 

Sincerely,

 

Peter V. Lee
Executive Director, National Health Policy
Pacific Business Group on Health
221 Main Street, Suite 1500

San Francisco, CA 94105

Phone: 415-281-8660

E-mail: plee@pbgh.org