Groups seek consensus on health care system reform

Stakeholders hope to cut through ideological differences and political ambivalence.

By Joel B. Finkelstein — Posted June 20, 2005

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Washington -- Two diverse health panels formed recently to address the need for health system reform in light of some troubling trends.

While the groups have slightly different goals, both cited problems such as the rising number of uninsured Americans and health care costs that continue to grow faster than the economy, as well as medical errors and racial and ethnic disparities.

Lawmakers' reaction to these problems has been underwhelming, said Robert Blendon, ScD, professor of health policy and management at Harvard University. The issues seemed to fall off the radar screen after the 2004 presidential election.

That realization has brought together a coalition whose members hope to cut through the ideological differences that have so far doomed large-scale reform proposals, said Ron Pollack, executive director of Families USA, which is leading the group.

"There seems to be a very deep interest among the stakeholders in the health care community to break through the logjam," he said.

The coalition, also led by UnitedHealth Group, has been meeting behind closed doors since late last year. The group has 24 members from a variety of organizations, some with opposing viewpoints on the issues. It includes representatives from the American Medical Association, the AFL-CIO, AARP, America's Health Insurance Plans, the Heritage Foundation, the U.S Chamber of Commerce, the National Governors Assn. and Pfizer.

In the past, groups have come to the table with their top priority and an all-or-nothing attitude, Pollack said. "If they didn't get their way, their second favorite choice was the status quo."

The members of the group are bound not to talk about the substance of their conversations, but the goal of their meetings is to reach a consensus plan that will expand coverage to as many people as quickly as possible, he said.

The coalition, whose members have been pushing for change for some time, realize that it needs to raise the level of discourse, Dr. Blendon said. With this new effort, it hopes to bring new proposals to the table that lawmakers can embrace in coming elections.

"They are trying to jump-start the discussion," he said.

Investing in improvement

Meanwhile, the Commonwealth Fund, a foundation better known for supporting research on health care and social issues, also recently announced that it had formed a panel devoted to putting the health care system on the road to improvement. The group is scheduled to meet for the first time in late July and will continue for as long as needed.

The Commission on a High Performance Health System has been tasked not only with offering proposals to improve the efficiency and quality of the health care system, but also with devising ways to measure that improvement, said Stephen Schoenbaum, MD, MPH, executive vice president for programs at the Commonwealth Fund.

The fund sought to bring diversity to the commission, including a range of experts, many of them with practical experience in the field. The panel includes representatives from medicine, health insurance, academia and government.

"What we were looking for is some breadth of interest and experience," Dr. Schoenbaum said. "We're hoping that the group as a whole will be able to combine their broad interests to find synergy and start breaking through into new ground in what have been pretty old plowed areas."

But rather than focus on just one issue, the new commission will be looking at the health care system as a whole, he said.

"Most of these issues, whether it's coverage, access, quality, efficiency or just cost, tend to be discussed in isolation," he said. "It occurred to us that it was important to try to look across these issues and see whether we could bring them together in some way."

Ultimately, the solution lies in the ability to improve the efficiency of the health care system and then reinvest any savings in raising quality and access, he said. To that end, the 18-member commission will produce two annual reports, one a "scorecard" gauging the performance of the health care system and another to follow that will offer recommended practices and policies designed to raise that score.

The fund is trying to bring together much of what has been learned about improving the health care system and find ways to implement those ideas, Dr. Blendon said.

Dr. Schoenbaum agrees.

"Everyone recognizes that there is significant room for improvement here. The task for the commission will be trying to think about what are a realistic set of goals and how one might think about practices and policies that will get us to those," he said.

He added that physicians can offer significant input in these discussions. More than a quarter of the panel members are doctors.

"Physicians do play an important role both in delivering care in the United States, but also in understanding what the issues are. We are going to have to play an important role in achieving higher performance with the health care system," he said.

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Health priorities

The Commonwealth Fund's new reform commission grew, in part, out of a series of surveys of health care experts conducted over the past several months. The first survey, including 318 respondents, asked them to rank the priorities lawmakers need to address over the next five years.

  • Expand coverage to the uninsured.
  • Improve the quality and safety of medical care.
  • Reform Medicare to ensure its long-term solvency.
  • Mitigate the rising cost of health care.
  • Alter Medicare payments to reward performance.
  • Control the rising cost of prescription drugs.
  • Address racial and ethnic disparities.
  • Reform the medical liability system.
  • Reduce administrative burdens.
  • Expand coverage through Medicaid.

Source: Commonwealth Fund, January.

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External links

Commonwealth Fund's Commission on a High Performance Health System (link)

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