Featured Articles
Building the Path to Accountable Care
December 29, 2011
The New England Journal of Medicine, by Elliott S. Fisher, Mark McClellan, and Dana Safran
The recent release of the regulations that will govern the early years of Medicare's implementation of accountable care organizations provides an important moment to reflect on the transition to this new payment model, which offers health care providers flexible financial support for improving care in return for accepting accountability for its overall quality and cost. It's also an appropriate moment to explore the challenges that must be overcome in order to make more rapid progress.
Medicare spending growth rising slower but enrollment will rise
December 22, 2011
The Washington Post, by Lori Montgomery
Throughout Medicare’s 46-year-old history, monitoring the cost of the government health plan for the elderly has been a bit like the old joke: No one asked if spending would jump. They only asked how high. But in early 2010, the number crunchers at Medicare headquarters in Baltimore saw something surprising: a sharp drop in the volume of doctor visits and other outpatient services. Instead of growing at the usual 4 percent a year, the number of claims was suddenly climbing by less than 2 percent. Was this a one-time blip, or a fundamental shift in how seniors were receiving care?
Analysis: Deficit may be biggest threat to healthcare reforms
December 18, 2011
Reuters, by David Morgan
A mounting U.S. deficit could pose a much greater threat to the survival of President Barack Obama's healthcare reforms than either the Supreme Court or 2012 elections. Many health experts say innovations in delivering medical care and the creation of state health insurance exchanges for extending coverage to the uninsured are likely to continue in some form even if Obama's 2010 Patient Protection and Affordable Care Act is struck down or repealed.
McClellan examines opportunities for improving health care
December 8, 2011
The Daily Princetonian
Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, presented a lecture on Wednesday titled "Bending the Health Care Cost Curve: Pathway to Real Reform,” in which he illustrated opportunities for improvement on the issue based on his experiences. With a Ph.D. in economics from MIT and an M.D. from the Harvard-MIT Division of Health Sciences and Technology, McClellan is also senior fellow of economic studies and the Leonard D. Schaeffer chair in health policy studies at the Brookings Institution
McClellan Unfazed by Storm of Criticism of ACO Proposal
June 27, 2011
CQ Healthbeat
Mark McClellan, the former Centers for Medicare and Medicaid Services administrator who is leading a concerted effort to spawn the growth of accountable care organizations, said that he expects Medicare officials to ink the first Medicare ACO contracts next spring. McClellan said the intense criticism of the ACO regulation proposed by CMS last March only shows how serious doctors, hospitals, and other providers are about creating the new organizations. The health overhaul law envisions these groups as bringing more efficient, team-based care to the traditional Medicare fee-for-service program.
Quality, Not Quantity: Private Firms are Taking Baby Steps to Curb Soaring Health Care Costs
June 16, 2011
The Economist
Wonks have buzzed about ACOs for years. In 2005 CMS began a pilot with ten health systems, including Geisinger, to reward them for improving the quality of care while lowering costs. America is dotted with examples of reform. Utah’s Intermountain Healthcare is a hospital system with its own health plan. Clever use of data has helped to streamline care: a new protocol for delivering babies has reduced the number of unplanned caesarean sections and saved about $50m a year. Insurers are experimenting with reform as well. Aetna, Humana and Wellpoint are testing new payment models.“The train is moving in the right direction,” says Mark McClellan, a former head of CMS who has championed ACOs.
Consensus: SGR Formula Not Sustainable. Now What?
June 8, 2011
Modern Medicine, by Annette M. Boyle and Michael Levin-Epstein
Since 1997, Medicare has reimbursed physicians according to the Sustainable Growth Rate (SGR) formula, a plan that critics say is fundamentally flawed. The SGR formula follows a target growth rate model linked to GDP. Thanks to an aging population and advances in technology, Medicare costs have outpaced the target. Now, however, the major players are starting to agree that it’s time to stop relying on last-minute reprieves (five in 2010 alone) to avert drastic cuts in reimbursement rates and find a Medicare payment structure that controls costs and reimburses physicians fairly. Former Centers for Medicaid and Medicare Services Administrator Mark McClellan — in testimony before the House Energy and Commerce Subcommittee — encouraged lawmakers to consider aligning some of the current programs with proposed changes to the SGR.
Seeing the Advantage in Delaying a Solution
May 29, 2011
New York Times, by John Harwood
The new health care law seeks to restrain health care cost inflation through steps to overhaul payment practices and service delivery: better information on effective treatments, improved coordination among doctors, financial rewards for the quality of treatment rather than the quantity. Some leading Republican policy experts agree that potential long-term savings from the law could be significant. “They’ve done a lot,” said Mark McClellan, who ran the Medicare program under President George W. Bush. But “there’s a lot more” cost-cutting that needs to be done, Mr. McClellan added. “They’ve only got a partial plan.”
Accountable Care Organizations in Health Reform Decoded
May 3, 2011
PBS NewsHour, by Betty Ann Bowser
Fragmentation and unnecessary testing are two of the hallmarks of medical care in the United States. They're also a major factor in what's driving the cost of health care through the roof. Enter a new idea: The Accountable Care Organization (ACO), a key provision in the new federal healthcare law. A major figure in the movement to ACOs is Dr. Mark McClellan who heads the Engelberg Center for Health Care Reform at the Brookings Institution. He also knows his way around the federal government, having served as both Commissioner of the Food and Drug Administration and head of the Centers for Medicare and Medicaid Services. Dr. McClellan told the PBS NewsHour online that ACOs will "enable care providers to get paid more when they do what they really want to do for patients--provide better care at a lower cost."
Medicare Officials Acknowledge Criticism of ACO Proposal
May 2, 2011
CQ HealthBeat, by Rebecca Adams
Top Medicare official Jon Blum said Monday that federal officials are taking seriously the many tough questions raised by the public about the proposed rule for accountable care organizations released March 31. Around the country, many medical providers are concerned that the rule’s requirements are so stringent that they won’t be able to participate, said Lawrence Kocot, deputy director of the Engelberg Center for Health Care Reform. “The result has been a lot of disappointment,” said Kocot, who spoke at a College of American Pathologists conference. “A lot of people feel that the agency fell short.”
Analysis: GOP Gets Its Turn on Medicare Hot Seat
April 11, 2011
Associated Press, by Ricardo Alonso-Zaldivar
Now it's their turn to try to fix the health care mess. Republicans, just like President Barack Obama, may discover that's easier said than done. The GOP budget expected to go to the full House this week would remake health care programs for the elderly and the poor that have been in place for nearly half a century. Budget Committee Chairman Paul Ryan, R-Wis., says his approach would "save" Medicare by keeping the financially troubled program affordable for federal taxpayers. Whatever happens to his budget, Ryan's general idea that seniors should bear more direct responsibility for decisions that affect health care costs isn't going away. "If everybody who bought health care was paying more when they get a more expensive plan, that would create a lot more pressure to bring costs down," said Mark McClellan, who ran Medicare for President George W. Bush. "There's reason to think that reforms that engage beneficiaries in getting less costly care will make a difference."
McClellan Sees Benefits from Ryan-Rivlin Medicare Plan (video)
April 4, 2011
Bloomberg TV's "Street Smart"
Mark McClellan speaks with Shannon Pettypiece, Carol Massar and Matt Miller at the 2011 World Health Care Congress, discussing challenges facing the U.S. health system and a proposal by Republican Representative Paul Ryan and Alice Rivlin.
ACOs in the Real World: HHS Envisions Lots of 'Unicorns'
April 1, 2011
Kaiser Health News, by John Reichard
The accountable care organizations that Medicare will launch in January are being likened to unicorns — such is their rarity in the real world of health care. But with the March 31 unveiling of a proposed rule for Medicare ACOs, it became clearer what an emerging market populated with teams of doctors, hospitals, and other caregivers might actually look like and how it will operate — at least from the government’s point of view. Mark McClellan, director of the Engelberg Center for Health Reform at the Brookings Institution and a leading proponent of ACOs called the proposal a “good foundation” but said there is much work left to be done. Asked about the projection of 75 to 150 ACOs, he said “I think it’s speculative at this point.”
New Reform Regulations Fire up Health Debate
April 1, 2011
POLITICO, by David Nather
Just about everyone in Washington who deals with health care policy is reading through the 429-page proposed rule on how to set up ACOs. The new entities will be networks of hospitals and doctors who will work together to share the care of Medicare patients and try to save money in the process. The likely savings — about $960 million over three years, according to the Centers for Medicare & Medicaid Services — aren’t huge compared with the costs of the law. But health care analysts said they could help put health care spending on a more reasonable path. “All of their [current] incentives go in the wrong direction, and this is a big step toward getting it right,” said Mark McClellan, a former CMS administrator under President George W. Bush and now director of the Engelberg Center for Health Care Reform.
Obama Administration Proposes Rules for Healthcare Partnerships
March 31, 2011
Los Angeles Times, by Noam Levey
The Obama administration proposed new regulations Thursday to encourage doctors and hospitals to collaborate more closely to improve patient care, a major goal of the sweeping healthcare law the president signed last year. The much-anticipated rules will reward new partnerships, known as Accountable Care Organizations, that deliver better results for Medicare patients. Many experts believe the ACO model could be replicated throughout the nation's $2.5-trillion healthcare system, a process that has already begun as hospitals, doctors and health plans scramble to form new alliances. "This is an important step," former Medicare and Medicaid director Mark McClellan said Thursday.
Accountable Care Organizations: A Framework for Evaluating Proposed Rules
March 31, 2011
Health Affairs Blog
The Centers for Medicare & Medicaid Services (CMS), the Office of the Inspector General, the Federal Trade Commission and the Antitrust Division of the Department of Justice, and the Internal Revenue Service have released proposed regulations for implementing Section 3022 of the Patient Protection and Affordable Care Act (ACA), the Medicare Shared Savings program. The program will govern the short-term implementation of Accountable Care Organizations (ACOs) in Medicare. Mark McClellan and Elliott Fisher outline the major issues that they believe will be important to consider as a very wide range of interested groups develop responses to the proposed regulations.
NIH Spending Imperiled by Republicans, Ignoring Gingrich Pleas
March 21, 2011
Bloomberg, by Catherine Dodge
When House Republicans took power in 1995 determined to cut spending in a battle that shut down the U.S. government, then-House Speaker Newt Gingrich was persuaded to spare the National Institutes of Health. Gingrich not only reconsidered his party’s proposed cuts to the NIH budget after hearing concerns from business executives and Nobel laureates, he later supported a bipartisan move to double the research center’s funding over five years. The budget for the NIH, the largest public funder of biomedical research in the world, rose to almost $31 billion in 2010 from $11.3 billion in 1995. The investment has paid off, said Mark McClellan, a former Medicare administrator under Republican President George W. Bush who leads the Engelberg Center for Health Care Reform at the Brookings Institution in Washington. But for Republicans who took control of the House this year, those concerns aren’t resonating, and the NIH lacks a Republican champion.
One Year Later, Healthcare Reform Debate Continues
March 21, 2011
MedPage Today, by Emily Walker
A year ago today, the House of Representatives, in a late-night vote, passed the Affordable Care Act, and 365 days later, the law is just as controversial as ever. Dueling perspectives on the law were on display in Washington on Monday with various groups holding events to commemorate the one-year anniversary. Events will continue on throughout the week that will no doubt continue to highlight the polarizing effect of the law. One thing most of the speakers at Monday's events agreed on: Healthcare reform is not over. "Health reform isn't going to stop with the Affordable Care Act," said Kavita Patel, MD, of the Engelberg Center for Health Care Reform at the Brookings Institution. "I think there's going to be part two and part three."
No Death Panels, Please, But Poll Shows Americans Can Handle End-of-Life Chat
March 8, 2011
National Journal, by Matt DoBias
Americans say they are not squeamish about death, with an overwhelming percentage supporting informed public discussion of the issue, according to a National Journal-sponsored survey. Roughly 3 out of 4 Americans, 78 percent, said that palliative care and end-of-life treatment should be part of the public discourse, and 93 percent said they believe such decisions should be a top priority for the U.S. health care system, according to a survey released Tuesday by the Regence Foundation and National Journal at a policy summit. “What is palliative care?... It depends on your own personal circumstances and preferences and what is available,” said Mark McClellan, former CMS administrator who now heads the Engelberg Center for Health Care Reform at the Brookings Institution.
Health Law Ruling Will Figure in 2012 Race
February 23, 2011
POLITICO, by Jennifer Haberkorn
Close observers of the Supreme Court expect a ruling on at least one of the many legal challenges to the health care overhaul in the late spring or summer of 2012 – just in time for it to be a major issue in the presidential election. A pending ruling on the constitutionality of the individual mandate is likely to force President Barack Obama and the Republican nominee into coming up with viable alternatives to the controversial provision. It’s among the law’s least popular provisions, and Republicans are likely to use its repeal as a key reason to put a Republican president in the White House. “It wasn’t popular to begin with, but all the publicity around the court case hasn’t helped,” said Mark B. McClellan, director of the Engelberg Center for Health Care Reform at Brookings and a former administrator at the Centers for Medicare and Medicaid Services. “It’s time to be thinking about ways to make the insurance markets work without” the mandate.
GOP Lacks Clear Health Care Plan
January 15, 2011
Washington Post, by Amy Goldstein
With the House preparing to vote this week on whether to repeal the health-care law, the chamber's new Republican majority is confronting a far more delicate task: forging its own path to expand medical coverage and curb costs. House Republicans have termed their strategy "repeal and replace." But according to GOP House leaders, senior aides and conservative health policy specialists, Republicans have not distilled their ideas into a coherent plan. A particular challenge for Republicans is how to handle the possible effect of removing the law's requirement, as they have vowed to do, that most Americans carry health insurance starting in 2014, said Mark B. McClellan, director of the Brookings Institution's Engelberg Center for Health Care Reform, who held several senior health-care positions in the George W. Bush administration. He said the GOP would need to be careful to find other ways to deter people from drifting in and out of the insurance market, depending on whether they need care.
FDA Moves Forward on Building Capacity to Scan Millions of Electronic Records for Safety Problems
January 12, 2011
CQ Healthbeat, by Rebecca Adams
The Food and Drug Administration plans in the coming year to tap about 70 million patients’ electronic medical records to investigate safety questions, such as whether people who take oral hypoglycemic drugs suffer a higher-than-usual number of heart attacks. The exercise is part of a pilot program that is laying the groundwork for the Sentinel Initiative, whose system is expected to allow the FDA to search the health data of at least 100 million people by July 2012 in an effort to conduct more-extensive monitoring of drugs and devices for years after they are approved. Participants at a daylong seminar sponsored by the Engelberg Center for Health Care Reform at the Brookings Institution said that the project leaders are taking care to protect the privacy and personal information of patients.
FDA 'Mini-Sentinel' System Up and Running
January 12, 2011
MedPage Today, by John Gever
The first phase of the FDA's ambitious Sentinel program for real-time monitoring of drug safety problems is now operational, allowing the agency to track events in 60 million Americans, officials said. At a meeting in Washington and in a simultaneous online publication in the New England Journal of Medicine, program leaders drew back the curtain on Mini-Sentinel, a pilot program that accesses patient databases maintained by health plans and other organizations. The FDA contracted with the Harvard Pilgrim Health Care Institute in Boston and the Brookings Institution's Engelberg Center for Health Care Reform to design the system, which is now capable of querying claims data on some 60 million individuals, without revealing identities of specific patients.
Insurers Clash with Hospitals and Doctors Over ACO Rules
January 9, 2011
Kaiser Health News, by Jordan Rau
The new health law encourages doctors, hospitals and insurers to team up in treating patients, but these groups already are at odds as they urge the government to set rules protecting their financial interests. At issue are "accountable care organizations," which the Obama administration hopes will spring up around the country, initially treating Medicare patients but eventually other people as well. But the ACO concept was written broadly. Lawmakers left it to regulators to figure out how to put the provisions into practice. Some architects of the ACO concept are also worried CMS may give providers too much leeway. "It's difficult to set up an ACO system where providers are able to simply pick and choose" their patients, says Mark McClellan, a former CMS director under President George W. Bush who heads the Engelberg Center for Health Care Reform at the nonprofit Brookings Institution. "It's hard to see how that kind of participation would actually work."
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