2010 Featured Articles
Embracing Incentives for Efficient Health Care
November 28, 2010
Wall Street Journal, by Anna Mathews
Spurred by incentives in the federal health-overhaul law, hospitals and doctors around the country are beginning to create new entities that aim to provide more efficient health care. But these efforts are already raising questions about whether they can truly save money, or if they might actually drive costs higher. Hospitals and doctors are scrambling to learn about accountable care organizations and preparing to participate. Efforts to teach providers about ACOs, backed by researchers at the Brookings Institution and the Dartmouth Institute and Premier, a health-care alliance owned by hospitals, have drawn about 180 participants so far, including hospital systems and doctor groups. "We do have technically a better capacity to support these changes" than in the past, said Mark McClellan, who directs the Brookings Institution's Engelberg Center for Health Care Reform.
Family Physicians Should Get Involved With Implementing Health Care Reform at State Level, Says Former CMS Administrator
November 28, 2010
American Academy of Family Physicians
Former CMS Administrator Mark McClellan, MD, PhD, considers the recently passed Patient Protection and Affordable Care Act an opportunity for family physicians to play a major role in implementing health care reform on the state level. McClellan gave the keynote address at the 2010 AAFP State Legislative Conference on November 13.
Medicare, Medicaid Quality Plan Unveiled
November 17, 2010
Los Angeles Times, by Noam Levey
The Obama administration on Tuesday announced new initiatives to boost the quality of medical care that Americans receive, laying the foundation for what many experts think could be one of the most far-reaching benefits of the new healthcare law. The 10-year, $10-billion effort — which proponents hope can reduce hospital-acquired infections, help ensure seniors take their medications, and more — has garnered far less attention than the politically charged debate about repealing the law. "This is an important step," said Dr. Mark McClellan, who headed the Medicare and Medicaid programs under President George W. Bush. "Even if there are big disagreements about the role of government … hopefully, we'll find some ways to find bipartisan agreement to do some of the things that improve care."
Medicare, Medicaid Payment and Delivery Models Face Scrutiny by New Agency
November 1, 2010
American Medical News, by Chris Silva
Leaders at the Center for Medicare and Medicaid Innovation will root out unnecessary services and treatments that result in preventable complications for patients. They also plan to develop more effective therapies that target chronic diseases, medical errors and safety concerns. Leading government and private-sector officials converged at a conference hosted on Oct. 18 by the Brookings Institution to discuss the direction the center needs to take to meet the health reform law's mandates. At the conference, former CMS Director Mark McClellan, MD, PhD, said CMMI will need to address some significant policy and technical challenges, including getting a handle on the numerous models that have already been researched, while also looking for new partners and possibilities.
Mixed Signals On Medicare Pilot Savings Project
October 28, 2010
The Fiscal Times, by Merrill Goozner
Over the past decade, Medicare ran a pay-for-performance, shared savings demonstration project with ten group physician practices on the cutting edge of raising health care quality in the U.S. But only five groups generated any savings, according to CMS, sharing about $25 million of Medicare’s $32 million in lower costs. Some experts say Medicare’s experience with the physician group practice demonstration project raises a warning flag over reformers’ high hopes for the dozens of demonstration projects aimed at lowering costs that were authorized in the Affordable Care Act. Mark McClellan of the Engelberg Center for Health Care Reform, who ran CMS during the George W. Bush administration and kicked off the physician group practice project, took issue with the skeptics. “We saw mixed results,” he said. “It’s already having an impact on Medicare.”
Patient Notification Requirements Expected in Proposed Rules, Former CMS Chief Says
October 27, 2010
BNA Health Care Daily Report, by Tom Gilroy
The Centers for Medicare & Medicaid Services will issue proposed regulations for accountable care organizations soon, probably before the end of 2010, and ACOs and physician groups looking to become ACOs should expect guidance on how they must notify patients who have been assigned to an ACO and what changes such a move will mean for them, a former CMS administrator said Oct. 25.Speaking at the National Accountable Care Organization Congress, Mark McClellan, who is now the director of the Engelberg Center for Health Care Reform at the Brookings Institution, also said more guidance was likely from the Department of Justice and the Federal Trade Commission on the implications antitrust regulations and other federal laws, such as anti-kickback statutes, may have on the formation of ACOs.
Experts: Medicare Changes Promising but Barriers Hard to Overcome
October 22, 2010
CQ Healthbeat, by Rebecca Adams
The new health care law contains several elements that are designed to revolutionize the way that Medicare pays for medical services. But leading policy analysts said at an American Enterprise Institute briefing Friday that many political and institutional challenges could keep that promise from being fulfilled. Mark McClellan, director of the Brookings Engelberg Center for Health Care Reform, noted that CMS has tested different ideas that appeared to work well and then the projects have lingered without being scaled up for the entire Medicare population. McClellan highlighted the Medicare Physician Group Practice demonstration that he oversaw as CMS administrator — it took five years to start up and, after nearly 11 years, is still being evaluated.
Health Law Can Cut Spending Growth But Other Steps Needed, Bipartisan Reports Says
October 22, 2010
CQ Healthbeat, by John Reichard
A new report by a bipartisan group of health policy analysts says the health care overhaul law creates “important opportunities” to lower growth in health care spending. But it also says other steps are needed, such as taxing high-premium health plans starting in 2014, not 2018 as is called for in the law. The report, “Bending the Curve Through Health Reform Implementation,” was released by the Engelberg Center for Health Reform at the Brookings Institution.
Chiropractic, Autism Care May Be Essential Under Obama Law
October 22, 2010
Bloomberg, by Alex Wayne
The health law passed in March requires that insurers led by UnitedHealth Group Inc. and WellPoint Inc. begin covering a package of “essential benefits” in 2014. The law doesn’t say what care should be included, leaving that up to the U.S. Department of Health and Human Services. That, in turn, has spurred a lobbying push by advocacy groups for chiropractic care, autism treatments and dozens of therapies. “If you cover a broader range of essential services, the cost of the benefit package is going to be higher,” Mark McClellan, who led the Centers for Medicare and Medicaid Services under former President George W. Bush and is now a researcher at the nonprofit Brookings Institution.
CMS Puts Thinking Cap On, Will Launch New Innovation Center
October 21, 2010
Federal Computer Week, by Alice Lipowicz
The Centers for Medicare and Medicaid Services will spend $10 billion during the next nine years on research into how to reduce health care costs while improving quality of care, its top official has said. CMS Administrator Dr. Donald Berwick outlined his goals and approach for the Center for Medicare and Medicaid Innovation this week during a conference at the Brookings Institution’s Engelberg Center for Health Care Reform.
Proving Innovation in Medicare
October 19, 2010
The New York Times, by David Leonhardt
The huge budget deficits that the country faces in coming decades are, above all, because of Medicare. The program will have to cover growing numbers of baby boomers while health costs are likely to keep going up. So any deficit strategy needs to focus on Medicare. In the new issue of the journal Health Affairs, two doctors, both former Medicare officials, have laid out a plan to do so. It would give expensive new treatments three years to prove that they worked better than cheaper treatments, or their reimbursement rates would be cut to that of the cheaper treatments. It is from far the most radical idea out there. The full costs of treatments would be covered for three years, which would still give companies an incentive to innovate. Recently, private insurance companies, including Aetna and Cigna, have begun experimenting with similar policies, notes Mark McClellan, the former head of Medicare.
HHS Readying New Health Care Innovation Office
October 19, 2010
Federal News Radio, by Max Cacas
According to the Affordable Care Act, HHS is supposed to open the Center for Medicare and Medicaid Innovation (CMI) to focus on improving payment and delivery methods to reduce program costs. Congress allocated $10 billion to pay for these pilot initiatives between 2011-2019. "It's reduction of cost without harming a hair on anyone's head," he said during the Engelberg Center for Health Care Reform at the Brookings Institution event Monday on the CMI's development. "It is about the reduction of cost through improvement, and that's the modern view of the approach to that aim."
Medicare Leaders Lay Out Focus of Innovation Grant Center
October 18, 2010
CQ Healthbeat, by Rebecca Adams
Top officials at the Centers for Medicare and Medicaid Services (CMS) on Monday outlined their framework for a new office that will distribute $10 billion over a decade in grants aimed at updating the nation’s health care system. “It’s taking more of my time to think through CMMI than almost anything else I’m doing right now,” said CMS Administrator Donald M. Berwick, referring to the new Center for Medicare and Medicaid Innovation. Berwick was speaking at an event sponsored by the Engelberg Center for Health Care Reform at the Brookings Institution.
Berwick Urges Collaborative Approach to Healthcare Improvement
October 18, 2010
The Hill, by Mike Lillis
The head of Medicare on Monday reiterated the agency's strategy for improving the nation's healthcare system. But success, warned Donald Berwick, will depend on how well government and the private sector work together toward common goals. Appearing at the Brookings Institution's Engelberg Center for Health Care Reform, Berwick, head of the Centers for Medicare and Medicaid Services (CMS), said the agency will focus on ways to promote better care, ensure better health outcomes and lower costs simultaneously.
Obama's $10 Billion Center to Fund Pilot Programs on Doctor Pay
October 14, 2010
Bloomberg, by Pat Wechsler
Last year, in the final days of President George W. Bush’s administration, the Centers for Medicare and Medicaid Services released a report saying the agency was aiming to change how doctors are paid within three to five years. The health bill created the Center for Medicare and Medicaid Innovation to address that goal. “There’s still a lot of work ahead and the challenge with pilots and demonstrations in Medicare is that they can take a very long time, they’re hard to expand elsewhere and they don’t always work,” Mark McClellan said in an interview. “But things are different than in the past. There’s much more of a mandate from Congress to take bold steps and there’s a lot more going on in the private sector about reforming payments.”
Win or Lose, Republicans to Target New Health-Care Law After November Elections
October 4, 2010
Washington Post, by N.C. Aizenman
"Repeal and Replace." That's what Republicans are saying about the new health-care law as they look toward the Nov. 2 midterm elections. If they win the House, and possibly the Senate, they say, among their top priorities will be to undo President Obama's signature legislative achievement. Republicans say they would try to deny any additional money Obama requests for implementation over the next two years, either by refusing to include it in the appropriations bill covering each agency or by tightening their overall budgets. According to Mark B. McClellan of the Brookings Institution, who ran Medicare and Medicaid under President George W. Bush, "the president may not get all that he wants in terms of implementation funding. But it may not be worth the political fight of holding up an entire appropriations bill."
Obama Makes Retail Sales Pitch to Defend Health-Care Overhaul
September 23, 2010
Bloomberg, by Drew Armstrong
Six months after the enactment of President Barack Obama’s health-care overhaul, the job of selling the plan has moved from Washington to locales like a church basement one block north of Philadelphia’s city hall. The Obama administration and its allies are relying on similar endorsements to counter attacks on the health-care overhaul. Republicans are making repeal of the law a centerpiece of an agenda they are unveiling in a bid to take control of Congress in November’s midterm elections. “It’s probably not surprising that there are not a lot of people who have been able to firsthand, or through friends or family, have a positive experience with an aspect of the law,” said Mark McClellan, director of the Brookings Institution’s Engelberg Center for Health Care Reform in Washington.
Will Health Law Provision Suffer Face of 'Doc Fix'?
August 25, 2010
National Journal, by Meghan McCarthy
Republicans continue to hammer Democrats over the new health law's impact on Medicare, arguing that reducing the program by an estimated $500 billion will weaken seniors' benefits. But doubts persist about whether one of the largest cost-savers in the law, which reduces the annual inflation updates to nonphysician provider payment rates, will ever take full effect, or if it is doomed to repeat the fate of the much-maligned "doc fix," an annual reduction to the reimbursement rate for Medicare doctors that Congress habitually overrides. Not all health experts are as convinced that reductions to provider payments are destined to become the next "doc fix," arguing that the cuts can happen if Medicare is able to change the way it pays providers and rewards both hospitals and doctors for quality of care over volume of services. "We haven't done it yet, but that doesn't mean we can't," said Mark McClellan, a former CMS administrator in the George W. Bush administration, of maintaining the cuts to nonphysician providers.
Sebelius Could Face Health-Reg Fight
August 23, 2010
POLITICO, by Jennifer Haberkorn
Health and Human Services Secretary Kathleen Sebelius could find herself pitted between top Democrats on Capitol Hill and state insurance commissioners over a key section of the health care overhaul. Sebelius is waiting for the National Association of Insurance Commissioners to suggest rules surrounding how much insurance companies must spend on medical costs versus administrative expenses or profits. The report, expected in weeks, isn’t likely to be as strict on insurers as top Democrats have hoped. “The implementation of many aspects of this law will be controversial,” said Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution and a former administrator at the Centers for Medicare and Medicaid Services. “That could potentially add to the controversy,” he says.
Donald Berwick Takes Charge of Medicare and Medicaid
August 21, 2010
The Lancet, by Nellie Bristol
Berwick is now on the job, figuring out how to implement the significant changes called for in government programs by the health-care reforms. He has a long history of developing and nurturing systems changes that increase quality and reduce costs, but transferring that innovative bent to the US$800 billion Medicare and Medicaid systems will be difficult. “It's a real challenge because this is a very large government program that literally tens of millions of Americans depend on,” said former CMS Administrator Mark McClellan. “You've got to be careful about making changes. At the same time, without changes in how Medicare pays, it's awfully hard to see how health care providers and patients are going to be able to reform care in ways that really improve quality.”
Are Bigger Health Care Networks Better or Just Creating a Monopoly?
August 16, 2010
Washington Post, by Alec MacGillis
Carilion Clinic in Roanoke says it represents an ideal envisioned by the nation's new health-care law: a network that increases efficiency by bringing more doctors and hospitals onto one team, integrating care from the doctor's office to the operating room. The name for such networks, which the new law strongly promotes with pilot programs, is accountable care organizations, or ACOs -- providers joining together to be "accountable" for the total care of patients, with incentives from insurers to keep people healthy and costs down. But skeptics apply a more old-fashioned term to networks like Carilion: monopolies, which they say will make health care even more expensive. "This is a path to giving doctors and health professionals more resources for doing what they think is right for patients," said the Brookings Institution's Mark McClellan, who ran Medicare under President George W. Bush.
Comparative Effectiveness In Health Care
August 13, 2010
CQ Healthbeat, by Rebecca Adams
With comparative effectiveness about to ramp up significantly under the new health care law, the government will need to develop a plan to manage it, decide how the research will be used, and figure out how to incorporate it into the delivery of health care and how to factor it into decisions by the government and private insurers about coverage. But as of now, no one really knows what role the research will play in the medical system five, 10 or 20 years down the road. “It’s hard to say at this point,” what the research will look like, said Mark McClellan, a former administrator of the Centers for Medicare and Medicaid Services (CMS) during the George W. Bush administration. “The funding will grow to $500 million-plus in a few years . . . But the whole research strategy for how it’ll be carried out still has to be implemented, and there are a lot of different views about the best ways to conduct CER."
After Avandia: Does the FDA Have a Drug Problem?
August 12, 2010
TIME, by Massimo Calabresis with Alice Park
Examples of the drug industry's outmaneuvering FDA regulators are disturbingly common, say both scientists and policymakers who follow drug approval and safety monitoring. More than 140 million Americans take at least one prescription drug in any given month, and they rely on the FDA to ensure those drugs are safe. That trust, the story of Avandia illustrates, is a gamble. Senator Chuck Grassley wants to give FDA safety monitors even more power, and former FDA chief Mark McClellan says the agency should use newly computerized medical records to track safety data in near real time.
Healthcare Law Has More Doctor's Teaming Up
July 28, 2010
Los Angeles Times, by Noam Levey
As Congress debated the healthcare bill, many critics lamented it would do little to transform a system in which doctors and hospitals bounce patients around in an uncoordinated, costly, sometimes tragic process. But something unexpected has happened since President Obama signed the legislation in March. Spurred in part by the law, many independent providers across the country are racing to mold themselves into the kind of coordinated teams held up as models for improving care. Some experts and providers see the new courtship dances as a surprisingly hopeful sign. The healthcare debate may have helped spark doctors, hospitals and others to rethink what they do, raising the prospect of better outcomes for millions of Americans. "There are a lot of people who have reached the conclusion that they need to change the way they practice medicine," said Dr. Mark B. McClellan, a former Medicare and Medicaid chief in the George W. Bush administration and a leading advocate of more care coordination.
Health Care Law's Accountable Care Groups Attract Rare Bipartisan Favor
July 19, 2010
CQ Healthbeat, by John Reichard
Not only does the health care law launch experiments to test possible solutions to the complex problem of rising health care costs — it also gives the Health and Human Services secretary the power to push a redesign of how health care is delivered in the United States. Case in point: the secretary’s new authority to contract widely starting in 2012 with entities called “accountable care organizations” — groups of doctors, hospitals, and other caregivers that work together to improve the quality and efficiency of care. Adding to the sense of bipartisanship surrounding the care organizations is the leadership of Mark McClellan, who ran Medicare and Medicaid for President George W. Bush. Now at the Brookings Institution, McClellan, together with Dartmouth researcher Elliott Fisher, has established a “learning network” of some 100 provider and payer groups testing the organizations.
Appointee Will Have Big Role in Health Care Law
July 8, 2010
USA Today, by John Fritze
Donald Berwick, who President Obama named to head the Centers for Medicare and Medicaid Services, drew praise from top medical groups, including the American Medical Association, but Republicans criticized the administration's decision to use a recess appointment to bypass the Senate confirmation process. Berwick will also play a pivotal role in implementing Obama's health care law — from finding a way to trim about $500 billion out of Medicare over the next decade to expanding Medicaid coverage by 16 million people. The agency has "very broad authority under the new law," said Mark McClellan, who ran the agency from 2004 through 2006.
Recess Appointment Could Make Berwick's Job More Difficult
July 7, 2010
CQ Healthbeat, by Rebecca Adams and John Reichard
President Obama’s appointment of Donald M. Berwick to lead the Centers for Medicare and Medicaid Services during a congressional recess sidesteps a Senate confirmation fight, but could weaken the Harvard professor as he undertakes the task of implementing the new health care law, according to some health policy experts. Mark McClellan, who also served as a CMS administrator, praised Berwick’s credentials but said the questions he will not have to answer as a recess appointee are likely to be raised by lawmakers when he testifies before Congress — something that may complicate already-challenging decisions. “A lot will come back in the context of specific decisions that CMS is making,” McClellan said.
Drug Makers Will Share Data From Failed Alzheimer's Trials
June 11, 2010
Wall Street Journal, by Shirley Wang
Drug makers' attempts to find treatments for Alzheimer's disease have produced scant results and a long string of busts. Now a broad effort is under way to learn something from those failures. A group of major pharmaceutical companies will share pooled data from failed clinical trials in an attempt to figure out what is going wrong in the studies and what can be done to improve drug development. For the FDA, the project is something of a counter to criticism that it has been slowing down drug development because it is too focused on patient safety as opposed to on how well a drug works. Rather than debate whether the benefit-risk calculation for new drugs should be changed, the FDA wanted to help the industry develop better methods for determining if drugs are safe and effective, according to Mark McClellan, a former FDA commissioner who helped develop and support the coalition. "The whole point of this type of effort is to get out of that debate," Dr. McClellan said.
GOP Stalls Nomination For Leader of Medicare Agency
June 9, 2010
NPR, by Julie Rovner
Dr. Donald Berwick is President Obama's pick to head the Centers for Medicare and Medicaid Services. It's not only the agency that oversees the nation's two largest health care programs, but the one that will play a pivotal role in implementing the new health care law. Most major health industry groups back Berwick's nomination — as do the Democratic and Republican predecessors who have run the agency before. "Don is a person who's spent his entire career committed not just to talking about ways to make health care better, but actually helping organizations around the country change health care for the better," says Mark McClellan, who headed CMS under President George W. Bush. "And that's exactly the kind of background that CMS needs right now in order to find better ways to support high-quality care while saving money at the same time."
The Health Care Economy: Where the Jobs Are
June 7, 2010
The Fiscal Times, by Merrill Goozner
The pilot project drawing the most attention these days involves so-called accountable care organizations (ACOs), which are already being put in place by some communities without government assistance. Late last month, California’s largest insurer, Anthem Blue Cross, and two of Southern California’s larger physician-led medical groups launched an ACO that promises to hold down health care costs while improving quality. The California ACO project is being led by the Brookings Institution’s Mark McClellan, and Elliott Fisher of the Dartmouth Institute for Health Policy and Clinical Research. Previous Medicare pilot projects have also tied payments to improved quality. But none tied payment reform to organizational change. ACOs “are about giving providers more financial support when they take steps that improve quality and lower costs,” said McClellan. “They require clear (if individually incremental) steps to get these changes.”
Writing of Health Law Not Over Yet
June 6, 2010
Washington Post, by N.C. Aizeman
The health care overhaul may have slipped from the headlines since President Obama signed the bill into law in March. But the chore of putting the statute’s more than 2,000 pages of provisions into practice is keeping Washington’s policy makers and bureaucrats busier than ever. “How these regulations get written can have a real impact on how much health care reform we actually end up getting — and a lot of them need to get written within weeks,’’ said Mark McClellan, of the Brookings Institution.
Comparative Effectiveness Research Debated
June 5, 2010
MedPage Today, by Emily Walker
Health care policy experts met Thursday to discuss ways to ensure comparative effectiveness research includes groups who are at risk for poor health – including people with disabilities, minorities, and the elderly. At the seminar, hosted by the Brookings Institution, government officials, academics, researchers, and representatives from private companies discussed the importance of testing medical interventions in a wide variety of different populations.
Former Medicare Chief Says Comparative Effectiveness Research is Not Rationing
June 4, 2010
CNS News, by Matt Cover
On Thursday, speaking at a forum sponsored by the Brookings Institution, Mark McClellan – who was director of the Centers for Medicare and Medicaid in 2004-2006 – said the purpose of comparative effectiveness research (CER) was to help doctors avoid costly, unnecessary treatments, not to decide who does and who does not receive care. When asked about Donald Berwick’s views on CER and rationing, McClellan said he disagreed with the idea that CER is a tool for rationing and stated that it would lead to better, cheaper health care.
On Health Care, Lobbyists Flex Muscle
May 31, 2010
Boston Globe
A $3 million campaign by doctors, scanner operators, manufacturers, and groups devoted to women’s health helped persuade lawmakers to overrule Medicare administrators this year and restore much of the reimbursement for osteoporosis tests. It was a stark instance of a narrowly tailored, special-interest political victory in a law trumpeted by President Obama and Democrats as putting America on a path to a more rational health care system, where decisions are made on medical evidence and patient outcomes. Some wonder if it is a harbinger of more political fights over health pricing, as the medical industry tries to resist government efforts to link Medicare and Medicaid payments to things like medical evidence and patient outcomes. “In the future, as we get to tighter and tighter concerns about health care costs, is this going to happen more often?’’ said Dr. Mark McClellan, the former Medicare chief and now director of the Engelberg Center for Health Care Reform at the Brookings Institution.
Nurse-Family Partnership Deserves Investment
May 25, 2010
Dallas Morning News
If there is any hope that Congress' new health care bill will put some restraints around the growth in medical costs, it rests in the part of the proposal that calls for rewarding programs that reshape how medicine gets practiced. And "reshaping medicine" includes using research studies that point the way to the best practices. Reformers like Mark McClellan of the Brookings Institution call this "evidence-based" medicine. And the Obama administration has the chance to invest in one such program with Dallas ties – the Nurse-Family Partnership – when it starts giving out $1.5 billion in home health care grants later this year.
London Fog: Berwick and Britain's NHS
May 24, 2010
Kaiser Health News, by Jonathan Cohn
Who is Berwick? He’s one of the nation’s well-respected and best-known authorities on our health care system. A Harvard-trained pediatrician, Berwick has spent the last two decades studying how to make medical care more efficient, then spreading the word on how to do it. Mark McClellan and Gail Wilensky both praised Berwick’s nomination for CMS administrator. McClellan ran Medicare and Medicaid under President George W. Bush. Wilensky held the same position during the administration of Bush’s father. That's the same position for which Obama nominated Berwick, so you might think their opinion counts for something.
Private, Public-Sector Programs Illustrate What to Expect in Rules for Medicare's Pilot on Accountable Care Organizations
May 10, 2010
AIS Health Reform Week, by James Gutman
Provider groups gearing up to participate in the Medicare Accountable Care Organization (ACO) pilot programs created in the new health reform law face a daunting task of preparing. At least initially, ACOs probably will use claims-based measures and will measure savings based on a three-year trend, with the precise terms perhaps negotiated individually between CMS and each ACO to account for geographical and other differences, said Larry Kocot, a former top CMS official and now deputy director of the Engelberg Center for Health Reform at the Brookings Institution, which has been co-sponsoring a private-sector ACO initiative that influenced the ACO provisions in the reform law.
Writing the Rules for the Health Law
May 1, 2010
The National Journal, by Marilyn Serafini
Implementation of the new health reform law stands to be a monumental task for the Obama administration this year and in those to come, with even bigger changes set to take effect in 2014. Mark McClellan says that the $1 billion provided to implement the law is probably not enough. And the "biggest challenge coming up fast" for HHS, he said, is ensuring that states and the federal government meet a June 23 deadline for establishing subsidized high-risk insurance pools for the people who are hardest to insure.
Health Care Law's Unfinished Business: Cost Curbs
April 25, 2010
Associated Press, by Ricardo Alonso-Zaldivar
What's it going to cost me? That's the single biggest unanswered question about President Barack Obama's new health care overhaul law - and its weak spot. Many experts believe the law falls short on taming costs, and that will force Congress to revisit health care in a few years. "Most people who have problems with health care costs now are not going to see much change in the next few years," said Mark McClellan, who ran Medicare under former Republican President George W. Bush. "Hopefully some of these ideas will work, but it's not automatic. I do hope we can revisit this in a more bipartisan manner."
Obama Spurs Harvard Hiring While UnitedHealth Buys
April 14, 2010
BusinessWeek, by Meg Tirrell
In the past, lawmakers sometimes viewed comparative effectiveness analysis – the process of determining whether one treatment works better than others – like a “Coke vs. Pepsi” taste test. That may change with Obama’s health bill, signed into law March 23. The legislation builds on $1.1 billion designated for this research in the stimulus bill and creates an institute specializing in comparative studies, with at least $500 million in annual funding starting in 2013. The institute created under the health bill will be funded with $10 million this year and may reach $500 million or more annually in 2013, according to an estimate from the Brookings Institution, a Washington-based nonprofit research center. The budget may increase if insurance rolls grow, Brookings estimates. The health bill covers the period through 2019.
Health: After the Win, No Time to Lose
April 3, 2010
CQ, by John Reichard
After the past 14 months, no one can doubt the resolve of Democrats to shape the nation’s health care system the way they want it. They have pushed the biggest overhaul ever through Congress and are battle-tested and brimming with confidence that what is now Public Law 111-148 will firmly take hold across several agencies in the federal government. But they face years of hard work — in a harsh political environment — both to get the law implemented and to sell it to a skeptical public at the same time. As overwhelming as the job might seem, it’s manageable if agency heads began the planning “yesterday,” says Mark McClellan, who led the implementation of the Medicare overhaul in the Bush administration. McClellan, now director of the Engelberg Center for Health Reform at the Brookings Institution, thinks one of the most important challenges will be establishing the program for people to purchase subsidized coverage through insurance exchanges, which are expected to be up and running in every state by 2014.
Debate Brews Over Expansion of Internal Revenue Service's Work Force
April 1, 2010
POLITICO, by Carrie Budoff Brown
Health reform may have finally become law, but the partisan wars over the bill continue to rage — and the latest flash point is a debate about whether the $940 billion overhaul means thousands of new government workers are about to bloat the federal payroll. Republicans lawmakers are warning the law would put as many as 16,000 new Internal Revenue Service agents and workers on the streets. But Mark McClellan, former administrator of the Centers for Medicare and Medicaid Services, which implemented the 2003 Medicare prescription drug program under former President George W. Bush, said the personnel costs are quite likely to be much less than the GOP estimate. “My guess is that it is not going to be a huge increase in government staff,” McClellan said. “I do think the underlying dollar numbers are right; $5 [billion] to $10 billion is right. But most of that is not going to go to government staff.”
Outreach Aims for Trouble-Free Health Care Shift
March 31, 2010
USA Today, by Rich Wolf
Four years ago, a law intended to extend prescription drug coverage to millions of seniors temporarily had a reverse impact: hundreds of thousands with government coverage couldn't get medicines or were overcharged because of computer glitches and confusion. With the ink barely dry on this year's comprehensive health care law, the Obama administration and consumer and industry groups are readying education campaigns designed to stop history from repeating itself. That makes sense to Mark McClellan, who helped fix the Medicare drug program's early glitches in 2006 when he headed the Centers for Medicare and Medicaid Services. The program ran into trouble on day one when it tried to switch about 7 million seniors and people with disabilities from Medicaid to Medicare."That took some work to fix right around the start of the program," McClellan recalls. "There will unquestionably be bumps in the road on implementation."
Law May Do Little to Curb Unnecessary Care
March 29, 2010
The New York Times, by Gina Kolata
To truly change the nation’s chronic overuse of medical care, there will have to be a substantial change in the way patients think about health care, how medicine is practiced and how it is paid for, economists and doctors say. The legislation does little to help in those areas. The law includes pilot programs that Medicare is testing that pay doctors more for delivering better care at a lower cost. For example, groups of doctors can share in the savings to Medicare if they spend less money and improve the quality of their patients’ care. Such programs, linking medical outcomes and payments, might help if they were translated into Medicare policy, said Dr. Mark B. McClellan, the former leader of the Centers for Medicare and Medicaid Services, who is now at the Brookings Institution. But more should be done, Dr. McClellan said, considering the scope of the overuse problem.
Mark McClellan: 'The Affordable Care Act is an Important Step'
March 26, 2010
The Washington Post, by Ezra Klein
Engelberg Center director Mark McClellan spoke with Washington Post reporter Ezra Klein Friday morning about the Affordable Care Act and the next steps.
Signed, Sealed, Delivered
March 25, 2010
The Economist, by Vijay Vaitheeswaran
The Barack Obama who addressed Americans at near midnight on March 21st had every right to gloat. After a year in which his proposals for health reform were savaged by Republicans and leftists alike, and declared dead half a dozen times by everyone, he has somehow managed to get them over the finishing line. So how is the bill going to be paid? The CBO’s analysis suggests that the federal deficit will be slashed by well over a trillion dollars over the next two decades by this reform. Alas, explains Mark McClellan of the Brookings Institution, the most meaningful proposals have since been watered down or delayed.
Advocates Decried 'Doing Nothing' in Health Fight
March 25, 2010
Bloomberg, by Brian Faler
Republicans consistently argue the Democratic overhaul of U.S. health-care will prove financially disastrous for families, businesses and government. Advocates said the cost of doing nothing was worse by far. Mark McClellan, a physician who headed Medicare and the Food and Drug Administration during President George W. Bush’s administration, said the overhaul package “is dealing with some fundamental problems that we need to deal with; we can’t just continue to defer these. But could this be done a lot better? Certainly.”
U.S. Government Faces Huge Task, Cost to Implement Health Overhaul
March 22, 2010
Dow Jones, by Jarod A. Favole
Getting a U.S. health-care overhaul bill passed was a colossal task, and implementing the hundreds of provisions will now require Herculean efforts--and costs--by federal and state health-care and tax agencies, budget and policy experts say. "There's an enormous amount to do and the time to start was yesterday," said Dr. Mark McClellan, a former FDA commissioner and administrator at the Centers for Medicare & Medicaid Services, another agency at HHS. McClellan, who now directs the Engelberg Center for Health Care Reform at the Brookings Institution, said how the government implements the bill could help shape whether the public views the legislation positively or negatively.
Letter Tells CMS to Set More Specific EHR Goals
March 18, 2010
Modern Healthcare, by Jennifer Lubell
To successfully implement the broad use of electronic health records, the CMS needs to make its health goals and targets more explicit, according to public comments submitted by healthcare leaders from 56 organizations on the agency's meaningful-use rule. "Health information technology can be a very effective tool to help providers and patients get better, less costly care. That's why investments in health IT should prioritize key quality and outcome reporting requirements, while also streamlining the administrative overhead,” Mark McClellan, director of the Engelberg Center at Brookings and former CMS administrator, said in a written statement. “Our comments lay out a feasible path toward measuring and supporting a key goal of healthcare reform—achieving better results for patients—so that providers can focus their efforts on what's most important for reaching this goal.”
Tucson Medical Center Picked to Pilot Program to Improve Patients' Health, Reduce Costs
March 12, 2010
Inside Tucson Business, by Jane Erikson
The ACO, or Accountable Care Organization, brings together doctors and hospitals who agree on ways to reduce costs while improving patients’ health. Reducing health care costs and improving patients’ health — it could be the win-win for health care reform. And the national spotlight is focused on Tucson Medical Center and its affiliated physician groups for testing the concept. A joint initiative of the Engelberg Center for Health Care Reform at the Brookings Institution and the Dartmouth Institute for Health Policy and Clinical Practice has selected TMC as one of three hospitals for a pilot project of the concept.
Federal Leaders Promote ACOs as Part of Health Reform
March 11, 2010
Health Leaders Media, by Joe Cantlupe
Current and former top Medicare officials told an American's Health Insurance Plans conference on Wednesday that new directions for healthcare payment reform could include public and private collaborations, such as Accountable Care Organizations. "We are going to have to make some real changes to healthcare delivery, and not with short-term fixes," said Mark McClellan, MD, director of the Engelberg Center for Healthcare Reform at the Brookings Institution. McClellan is a former administrator at the Centers for Medicare and Medicaid Services and former commissioner of the Food and Drug Administration.
Nemours Helping Put 'Let's Move' In Motion
March 9, 2010
Delaware News Journal, by Kelly Bothum
In announcing her nationwide campaign, "Let's Move," last month, first lady Michelle Obama talked about the need for children to be more physically active, for families to have access to healthier lifestyle choices and for schools to serve tasty, nutritious food to students. Nemours hope to take this kind of success nationwide through its participation in the Partnership for a Healthier America, an independent, nonpartisan foundation recently created with five other private-sector health organizations. The partnership, which will work in conjunction with the "Let's Move" campaign, aims to come up with workable solutions to the nation's child obesity epidemic, a pressing health problem that threatens to reduce the life- span of American youths. "Nemours is a great example of a local organization with a national reach," said Larry Kocot, interim leader of the partnership as well as deputy director of the Engelberg Center for Health Care Reform. "If you look at something like 5-2-1 Almost None, it's elegant in its simplicity. It shows you don't have to reinvent the wheel to help show other communities what works."
Medicare Doctor Puts Patients on Hold as Annual Fee Cut Looms
February 26, 2010
Bloomberg, by Alexandra Thomas
A 21 percent payment cut for Medicare physicians is set to begin next week, based on annual fee reductions from 2002 that were baked into a formula that Congress created in 1997 to slow growth in government spending. The U.S. House of Representatives voted yesterday for a one-month delay in the reductions as part of a $10 billion employment bill that also would help the jobless buy health insurance. The legislation, which the Senate may take up next week, would give lawmakers more time to debate the fee cuts. The uncertainty “makes it very hard for physicians to plan ahead, and some providers will have a cash-flow problem,” said Mark B. McClellan, a physician and health-care analyst at the Brookings Institution, a policy research foundation in Washington.
McClellan, Jennings Discuss Health-Care Summit
February 26, 2010
Bloomberg TV
Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, and Chris Jennings, president of Jennings Policy Strategies, talk with Bloomberg's Margaret Brennan about yesterday's bipartisan summit in Washington on stalled health-care legislation.
White House Punts on Containing Health Costs
February 24, 2010
POLITICO, by Chris Frates
At Thursday’s health summit, President Barack Obama is almost certain to highlight the importance of reining in skyrocketing health care costs. But in his own health care bill, it’s a different story. Obama has put off a tax on high-cost health plans until 2018 — long after he’s out of office, even if he’s a two-termer. And in doing so, he’s essentially neutered the last significant Democratic push to control health costs. “This was designed to get more support from the Democratic Caucus. Not surprisingly, there’s higher overall costs and fewer steps to get the savings necessary to pay for those costs,” said Mark McClellan, a former Clinton and Bush administration official who is now a health care economist at the Brookings Institution.
Doctor Shortage Fuels Nurses' Push for Expanded Role
February 22, 2010
Kaiser Health News, by Andrew Villegas
Nursing leaders say large numbers of practitioners will be needed to fill gaps in primary care left by an increasing shortage of doctors, a problem that would intensify if Congress extends health insurance to millions more Americans. Advocates say nurse practitioners have the extra education and training needed to perform a variety of services, including physical exams, diagnosis and treatment of common ailments and prescribing drugs. And nurse practitioners are gaining support. In September, the nonpartisan Brookings Institution's Engelberg Center for Health Care Reform issued a report by 10 experts that said one way to curb health care spending is to encourage states to permit "greater use of nurse practitioners, pharmacists, physician assistants, and community health workers."
How the G.O.P. Can Fix Health Care
February 21, 2010
The New York Times
As President Obama invites Republican leaders in Congress to bring their best ideas forward for slowing the growth of health care expenditures and expanding the number of insured Americans, Engelberg Center Director Mark McClellan outlines what he believes those ideas should be, alongside other recommendations for bipartisan compromise.
Congress or No Congress, Change is Ahead for Health Care
February 2, 2010
Dallas Morning News, by Jim Landers
It's now apparent that an overhaul of the medical care establishment won't emerge from Congress any time soon. For employers trying to figure out health insurance mandates, penalties and taxes contained in the legislation, this impasse may be a good thing. It could unlock some hiring decisions otherwise clouded by uncertainty over employee benefit costs. For the governments (meaning taxpayers), companies and individuals who now pay for health care, however, this is another bleak year. Locally, it's even worse. In the 12 months ending in November 2009, medical care costs in the Dallas-Fort Worth area rose 12.3 percent, according to the most recent data from the federal Bureau of Labor Statistics. The increase was attributed primarily to higher hospital costs. Health economist Mark McClellan of the Brookings Institution, who helped get the Dallas dialogue started, said the legislative stalemate in Washington has prompted more communities to ask for help.
Obama's Budget Increases Funding for Medical Research that Compares Treatment Options
February 1, 2010
Kaiser Health News, by Mary Agnes Carey and Julie Appleby
The Obama administration, in an effort to forge ahead with its sometimes-contentious effort to compare various medical treatments, is proposing a big boost in funding for the agency that oversees the research. Proponents say the research can provide patients and their doctors with crucial information to help them decide among various drugs or treatments. Critics, on the other hand, say the research could be used to limit or ration care if the federal government or insurers used the information to deny coverage for a particular test or procedure because it was found to be less effective. Engelberg Center for Health Care Reform Director Mark McClellan said while many health care groups support the intent of comparative effectiveness research, “the next round of the debate is whether there is a way for Congress to comfortably support developing better evidence to guide individuals’ decisions without raising this fear of controlling those decisions….Whichever side of the debate you’re on, we need better evidence.”
Dems Weigh Whether Health Bills 'Are Dead'
January 22, 2010
USA Today, by John Fritze
As they try to pick up the pieces of their scorched health care legislation, Democrats in Congress are focusing first on the most popular ideas, from expanding patients' rights to making insurance coverage more affordable. Breaking up President Obama's health care legislation — which would have expanded health coverage to 30 million Americans— or shifting to a scaled-down bill that might win bipartisan support are among two options Democrats are considering. Many well-liked items in the bill are linked to more controversial ideas, said the Brookings Institution's Mark McClellan. That is partly because of the complexity of the nation's health care system, he said. "People didn't develop a trillion-dollar bill because they wanted to spend a trillion dollars," he said.
Paring Back Health Care Isn't As Easy As It Sounds
January 21, 2010
Associated Press, by Ricardo Alonso-Zaldivar
Trimming back the 2,000-page, trillion-dollar Democratic health care bills to the parts average people understand and like may not be as simple as it sounds. A complete ban on insurance companies' denying coverage to people with medical problems would be out of the question. Forget about guaranteed health insurance for all Americans; it costs too much. Still, lawmakers might be able to craft legislation that takes some rough edges off today's coverage problems and makes progress in controlling costs. Some limitations on health insurance companies are feasible, said Mark McClellan, who served as Medicare director for President George W. Bush. "There is a starting point," said McClellan. "There is a way to do something meaningful without going to requirements for coverage and trillion-dollar subsidies."
What About Costs?
January 20, 2010
The Wall Street Journal, by Mark McClellan
Many health experts are rightly skeptical that the current health-care reform legislation will lower spending growth, despite its many promising pilot projects and proposals. At the heart of the legislation is what supporters describe as all of the best ideas for paying doctors and other health care providers to deliver better care. Many ideas have been proposed to improve how doctors could work together to reduce complications of diabetes and other chronic diseases, such as by using electronic medical records or working with nurse practitioners who can help patients use their prescription drugs more effectively.That's a worthy goal, but only part of what's needed to lower spending growth.
Tinkering With the Cadillac (subscription required)
January 16, 2010
The National Journal, by Marilyn Serafini
As Democratic leaders face the daunting task of merging the House- and Senate-passed health care reform bills, possible compromises could weaken two of their most promising cost-containment provisions. One of the provisions, which appears only in the Senate bill, would impose an excise tax on high-end, or "Cadillac," health insurance plans that would save $149 billion over 10 years, according to the Congressional Budget Office. Mark McClellan, director of the Brookings Institution's Engelberg Center for Health Care Reform, worries that negotiators will change provisions to index the threshold amounts to inflation over time. "There's some debate about whether it's in or not. I do think that one place opponents of this tax provision might go, if [the Cadillac tax] stays in, would be to focus on changing the indexing so it doesn't have a bigger effect over time. Hopefully, that won't be the case," he said.
Lack of Medicare Chief Is a Strike Against Reform
January 12, 2010
The New York Times, by David Leonhardt
The lack of a Medicare nomination suggests that the White House is not giving enough attention to what will happen once Mr. Obama signs a bill. Within months, Medicare will need to begin creating pilot programs meant to reduce wasteful care and reward good care. Medicaid will have to plan a huge expansion. Mark McClellan, who ran Medicare from 2004 to 2006 and now works at the Brookings Institution, argues for adding in a few billion dollars to give Medicare the resources to act more quickly. Another sensible step may be to go with the House’s national insurance exchange, rather than two different exchanges for each state, as the Senate bill calls for.