By John Reichard, CQ HealthBeat Editor
April 11, 2013 -- The strange bedfellows approach to influencing health policy—unifying groups that sometimes clash behind a common set of principles—can pay off. After all, it played a part in producing enough of a stakeholder consensus to allow passage of the 2010 health care overhaul. Now a similar effort is getting started to "bend the curve" in health spending.
Called the "Partnership for Sustainable Health Care," the group has some of the same names and faces involved in the consensus building efforts that preceded the health law. They include Ron Pollack, director of Families USA, Karen Ignagni, president of America's Health Insurance Plans and John Rother, an AARP lobbyist at the time who is now the president of the National Coalition on Health Care.
Rounding out the five-member group is David Lansky, president of the influential Pacific Business Group on Health, an employer coalition on the West Coast, and Robert Henkel, CEO of St. Louis-based Ascension Health, the nation's largest Catholic health system.
Because of the health care law (PL 111-148, PL 111-152), "coverage expansion is going to happen," Pollack said at a news briefing last week to announce the group's principles. That has been settled, he said. But now a broad-based effort is needed to rein in spending, not by shifting costs between the public and private sector—the usual inside the Beltway formula—but by bending down the curve in overall health spending.
"The question for us in this room is how do we sustain that," Pollack said of the expanded coverage under the health care law, which he described primarily as a vehicle for signing up millions of uninsured Americans for health coverage. "The same thing is going to be needed for cost and quality," he added.
Although its set of principles has some new elements, the group's prescription is similar to that of other recent proposals for controlling costs. But what's different, its architects say, is the involvement of key stakeholders, their commitment to the job ahead, and their emphasis on controlling overall health spending—not simply spending in government entitlement programs.
Among its newer elements is a call for a state-by-state approach in which local stakeholders agree on their own formula. "Health care is local," said Ignagni. States should convene the players in their health systems to map out a campaign to bend the cost curve, she added. "States that participate would outline specific savings goals, with defined rewards for meeting them," the group said in a news release.
The group says that over the next five years, public and private payers should test new payment and health care delivery models that reward higher quality care and discourage simply performing lots of tests and procedures. Payers should pay more for services that are shown to have value and less for those that aren't. Benefits should be redesigned in the private sector so consumers pay lower out-of-pocket charges when they opt for evidence-based treatments and high-quality providers. Within three years, Medicare "should be modified to allow tiered cost-sharing for beneficiaries who use high quality providers, and drugs and services that are proven cost effective," the group said.
The coalition also wants a "uniform and prudent set of quality and other performance measures" used by both government and business.
"Ultimately it's going to be the key interest groups that are going to bring something over the finish line," Pollack said. The next step is to recruit other interests to join in the effort, including those representing business, hospitals, doctors, consumers, and pharmaceutical companies. "If they are not brought in, we are not going to achieve significant change," he said.
Officials said the announcement is not a prelude to going to the Hill to seek legislation. The aim is to build broad-based consensus, they said. But legislation will eventually be needed at both the state and federal level to accomplish the goals of the group, Rother said. And an overhaul of the Medicare physician payment formula involving development of new forms of health care delivery could present one such opportunity for pushing its agenda.
