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Bolder Action Needed to Bend Cost Curve, Coalition Says

By John Reichard, CQ HealthBeat Editor

The language is polite, but a new report by a coalition pushing for better preventive care says the congressional health overhaul effort is missing the mark when it comes to managing chronic disease and isn't doing enough to bend the health spending curve as a result.

"While everyone agrees that making health coverage affordable is the key to providing health care to all, no congressional proposal has yet put forth a plan for how we deliver, administer, and pay for health care that is bold enough to make this goal attainable and sustainable while being comprehensive enough to improve health," says the report by the Partnership to Fight Chronic Disease.

Current overhaul proposals "are a great start, and certainly preferable to the status quo, but...there is more work to be done and bolder action needed from Congress," said Ken Thorpe, the partnership's executive director.

"To 'bend the spending curve' we need comprehensive reform of the payment and delivery systems, creating a system that truly incentivizes high quality care through prevention, care coordination, and other efforts," added Thorpe, a health policy professor at Emory University, during a telephone press briefing Tuesday.

For example, Thorpe said that current proposals do not go far enough to "bundle" payment—in other words, to pay multiple providers a single payment that incentivizes them to avoid unnecessary tests and procedures. Through better coordination of treatment, more of the payment is left over for providers to pocket.

Thorpe also pointed to presentations Monday at a White House event on various health care systems he said effectively coordinate care and offer preventive services. The systems included the Geisinger Health System in Pennsylvania and the Dartmouth-Hitchcock Clinic in New Hampshire. Legislation should go beyond current proposals for pilot programs in this area, Thorpe suggested.

"Our belief is that we have ample evidence about how to proceed with preventing and managing chronic disease nationally and that while the pilots are a great start, if we wanted to be more aggressive with this we could build on those experiences that we have nationally already, scale them and replicate them in the Medicare program and I think we could do this within the next three years."

"We'd need some funding to do it" but every dollar invested in care coordination would yield two to four dollars in savings based on the White House presentations Monday, he said.

The report says that current proposals do not do enough to build on various existing programs, such as a University of Pennsylvania program that aims to better plan oversight and treatment of patients once they leave the hospital to avoid readmissions and skilled nursing facility care.

Thorpe also said he would like to see bolder congressional action to promote "community health teams" of nurses and social workers to work with smaller medical practices to provide "medical homes" to better oversee the treatment of those with chronic disease.

The House overhaul measure (HR 3200) provides $1.5 billion over five years for a pilot program in this area, but Thorpe estimated that if $25-to-$30 billion were invested instead to build the teams nationally over 10 years, $100 billion could be saved nationally by cutting hospital admissions in half.

While policy analysts and politicians emphasize better preventive care as a goal of health overhaul efforts, the Congressional Budget Office isn't scoring savings as a result.

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