By Rick Norling
Healthcare reform seems to be an aggregation of three high-level reforms: insurance reform, delivery-system transformation, and coverage for some 45+ million uninsured. Existing legislative drafts appear to call for all three to begin at the same time, with some sort of fail-safe strategy if the insurance and delivery-system reforms do not succeed. In general, this would seem to involve significant payment reductions to providers and various penalties to insurers.
The potential for complication with this implementation is enormous, with potential Draconian impacts on both hospitals and doctors. While all but the uninformed or extremely dogmatic acknowledge the need for broad transformation, there are plenty of appropriate questions regarding the time needed for this to occur effectively.
Consider an alternative akin to JFK’s “ man on the moon in 10 years,” namely a “Big Hairy Audacious Goal,” articulating all of the desired outcomes coming together over time. Since, in general, coverage of the uninsured is beneficial to hospitals, doctors and insurers (if disastrous financial consequences are not present), using Medicare value-based purchasing leverage to incentivize delivery-system reforms seems a powerful and appropriate first step. As the delivery system in total, or as selected states/regions of the country, begin to show the desired cost/quality trends, federal financing for the uncovered populations could then be initiated. Where that does not occur in an appropriate time frame, the threat of a public insurance program and of payment cuts could then be implemented. With this approach, productive and innovative health delivery and financing organizations will see a real upside for collaborative improvement and system transformation in the direction of hastening affordable coverage for uninsured populations.
By Rick Norling
Healthcare reform seems to be an aggregation of three high-level reforms: insurance reform, delivery-system transformation, and coverage for some 45+ million uninsured. Existing legislative drafts appear to call for all three to begin at the same time, with some sort of fail-safe strategy if the insurance and delivery-system reforms do not succeed. In general, this would seem to involve significant payment reductions to providers and various penalties to insurers.
The potential for complication with this implementation is enormous, with potential Draconian impacts on both hospitals and doctors. While all but the uninformed or extremely dogmatic acknowledge the need for broad transformation, there are plenty of appropriate questions regarding the time needed for this to occur effectively.
Consider an alternative akin to JFK’s “ man on the moon in 10 years,” namely a “Big Hairy Audacious Goal,” articulating all of the desired outcomes coming together over time. Since, in general, coverage of the uninsured is beneficial to hospitals, doctors and insurers (if disastrous financial consequences are not present), using Medicare value-based purchasing leverage to incentivize delivery-system reforms seems a powerful and appropriate first step. As the delivery system in total, or as selected states/regions of the country, begin to show the desired cost/quality trends, federal financing for the uncovered populations could then be initiated. Where that does not occur in an appropriate time frame, the threat of a public insurance program and of payment cuts could then be implemented. With this approach, productive and innovative health delivery and financing organizations will see a real upside for collaborative improvement and system transformation in the direction of hastening affordable coverage for uninsured populations.