Up Front

Better Health Care at Lower Costs: Real Health Care Reform

Mark B. McClellan

The passage of comprehensive health care reform legislation presents tremendous opportunities to improve the way that America’s health care system works. Reforms to expand coverage hold the potential to help millions of Americans. But in order to sustain this coverage and assure it provides access to innovative care, we need to focus on helping all Americans get the best care, not just better coverage.

While the new law will result in many more Americans having access to health insurance, changes in insurance coverage alone won’t ensure that they receive high-quality, innovative health care. Instead, how health care reform legislation is implemented will be critical to this effort.

Focusing on quality. Currently, information on the quality and cost of health care is woefully inadequate. However, a number of provisions in the law provide a stronger foundation for addressing quality of care – establishing broad national priorities for quality improvement and taking steps toward implementing nationally-consistent performance measures that focus on outcomes, patient experience, and other aspects of care that really matter to patients. Having such information about the performance of doctors, hospitals, and other health care providers can provide a trusted basis for changing payments, benefits, and other health care policies. But it’s not just about measuring cost and quality of care; we must also take feasible steps to act on those measures and improve care.

Paying for better care, not more care. Some of the most important payment system reforms are those that pay doctors and hospitals more when they get better health outcomes at an overall lower cost – and that make it easier for doctors and patients to change the way that health care works to make that happen. 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. The most important reforms on the payment side don’t tell doctors and hospitals what they need to do but support them when they figure out how to do things better.

Supporting improvements with better evidence. Provider payment reforms included in the law represent – as the President likes to say – a lot of the ideas that experts have put forth. The challenge is that we don’t really know which of these will actually work best, so we’ll have to find out quickly which of those reforms really work to improve care and lower costs. This will require doing a fundamentally better job of running the pilot and demonstration programs in Medicare. Typically, these can take eight to 10 years to test and evaluate proposed reforms – and we don’t have that kind of time to reduce spending growth.

Indeed, more and better information that’s more readily available is needed to support wide-ranging improvements not only in the quality and value of care, but across the health care system. This data can do important things to improve quality and payment system reforms, but can also support other needed changes, such as improvements in medical product safety.

Health care reform has been enacted, but the hard work is far from over. Much more can and must be done to ensure that health care in the U.S. really does become a system of highly innovative care at lower costs for all Americans.

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