Question

You are the governor of a mid-sized industrial state. You have just read this chapter and have decided that you want to make reforms to the health care and services delivery systems in your state to increase access to care for vulnerable populations. How would you proceed? Who would you have assist you. What is the time line for this charge?

Answer 1

Delivery System Reform

Policymakers generally agree that the U. S. healthcare system’s reliance on fee-for-service, third-party financing has contributed to a system that produces high costs with uneven quality. The increasing recognition among policymakers of this dynamic has led to recent. reimbursement policies that attempt to move away from rewarding volume (fee-for- service) to rewarding value. Many delivery system reform efforts to date have sought to transfer risk to entities with better incentives for managing costs and delivering value to patients. One of the most successful examples of this has been Medicare Advantage, which has moved away from a fee-for-service model, improved incentives, and has generally produced higher value (better care per unit of cost) for patients. The success of Medicare Advantage is based on better empowering consumers—letting them determine what constitutes value, as opposed to deferring the judgement to Washington. As HHS Secretary Azar has stated, if the government writes the equation for value, the answer is never going to be cheap or simple, and special interests will find a way to manipulate it. Relying on the free exchange of information between buyers and sellers, among competing interests, can deliver better outcomes from our healthcare system at a lower cost with patients, not the government in charge.

Delivery System Reform-

- The administration should focus on identifying alternative payment models that allow free markets and patients to define value, rather than rely on technical and burdensome definitions invented in Washington.
- The administration should evaluate the best metrics for measuring value and quality in the healthcare sector, eliminating unnecessary and potentially counterproductive measures and reducing the burden on providers.
- The administration should ensure that smaller physician and provider practices are not unduly harmed by delivery system reform and corresponding requirements.
- The administration should ensure that these delivery system reform models, which aim to hold providers accountable to a set of population-based metrics and total spending, foster collaboration across systems within a geographic area and do not produce harmful consolidation, particularly horizontal consolidation.
- The Administration should pursue policies and programs that encourage value, competition, and choice, such as Medicare Advantage, and move away from a fee-for-service model.