Priorities for Reform

A sustainable health care system will require improvements in the quality and value of health care. There is now growing consensus that integrating efforts to improve access to affordable coverage with steps to promote real reforms in the delivery of health care will, in turn, improve the sustainability of both affordable coverage and medical innovation. Since its launch in July 2007, the Engelberg Center has taken major steps to help translate these objectives into concrete steps for effective action. The efforts currently underway at the Engelberg Center are focused on the following major goals for health care reform:

Develop better measures of quality and cost to drive higher-value health care. Broad-based, meaningful information about health care quality and cost is critical to support better care. This enables providers to get better payment when they take steps to improve the value of the care they deliver, and empowers consumers to make confident health care decisions in their wn best interest. Such measures will drive significant improvements in a system that fails to provide consistently high-quality care. To help make this goal a reality, the Engelberg Center is working to make consistent and useful information about the quality and cost of health care widely available through its High-Value Health Care Project.

Reform payments to providers and the financing of care to promote quality and value. There is now broad consensus that traditional fee-for-service (FFS) payment methods often do not support efforts by providers, consumers, and others to implement improvements in care and avoid unnecessary costs. But new payment systems that align provider reimbursement with improvements in care quality and efficiency face practical obstacles, and must be evaluated and refined. Such models may include payments tied to better results and lower overall costs, which could enable steps like these to “pay off.” These payment reforms will require moving beyond models of pay-for-performance (P4P) that feature relatively modest financial bonuses for specific processes or other activities layered on top of existing FFS payments. More fundamental changes are needed in provider compensation to promote greater value, but these payment reforms are evolving and must be implemented in ways that do not expose providers to unsustainable financial risks. To that end, the Center is developing Medicare payment reform proposals that would reward providers for improving overall quality and efficiency of care.

Generate better evidence on what works. Persistently large gaps currently exist in what is known about the clinical effectiveness of different treatment options for specific patient populations. Even when the benefits of a particular drug, device, or procedure are well understood, their cost implications may be unclear. Further, a key part of knowing what works is evidence on the best payment strategies, benefit designs, and other health care policies to translate this data on treatments into improvements in the delivery of medical care. The Engelberg Center is collaborating with public and private organizations to improve the science of determining the safety and effectiveness of medical products and services both before and after they reach the market. The Center is also leading collaborative efforts to find better ways to promote the effective use of medical treatments that are targeted to particular kinds of patients.

Encourage rapid and more efficient medical innovation that improves patient health. New technologies and scientific breakthroughs such as genomics hold tremendous promise for improving patient health through more targeted, prevention-oriented, and effective care. However, in many areas, these advances have been making slow and uncertain progress from the laboratory into standard medical practice that reliably improves health outcomes. There are many opportunities for new collaborations to update and improve the science of safe and effective product development with the additional goal of faster and more reliable implementation. Such progress will in turn permit more effective regulation of medical products and targeting to the patients most likely to benefit from them. The Engelberg Center is collaborating with public and private organizations – including patient and consumer organizations, political leaders, researchers, and the media – to improve the process of bringing new treatments to patients, particularly those with cancer, Alzheimer’s disease, and Parkinson’s disease. The purpose of these collaborative efforts is to outline a broad vision for improving the development process for disease therapies to achieve broad-based cost reductions and improvements in the predictability and effectiveness of ongoing research and development.

Accelerate and improve reform efforts at the state and regional levels. In the absence of large-scale national progress toward expanded affordable coverage in the current fiscal and political environment, many states have taken the lead in launching innovative approaches to improving the delivery of care to improve quality and lower costs. These efforts can also guide and support national reforms. The Engelberg Center is supporting and analyzing state and regional reform efforts, including convening state and national perspectives in government and the private sector to highlight states that are using multi-stakeholder and/or multi-payer approaches to improve the delivery of care, examining lessons learned and common themes, and identifying opportunities for building on best practices to develop a more robust state/national framework for delivery system reform.

Facilitate the broader adoption of health information technology (IT) as a tool for enhancing quality, efficiency, and transparency in the health-care system. Almost every industry has invested successfully in information technology to improve productivity – but health care has lagged behind. The Engelberg Center is working to change this, supporting collaborative approaches that encourage the use of technological tools that improve patient health while lowering overall costs. The goal is not to promote information technology for its own sake, but to identify and address financial and other barriers to its widespread and effective adoption in health care. For example, the Center is working with a wide variety of stakeholders to help develop business and operating models for increasing the adoption of interoperable health IT that will assist providers in improving quality and reducing costs. These efforts involve supporting government leadership in key areas where it is needed, such as privacy and security of electronic health information.