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CMWF Report Outlines Path to Health Reform
A Commonwealth Fund Commission on a High Performance Health System report published last month recommends a comprehensive set of insurance, payment, and system reforms that, if in place by 2010, could lead to affordable coverage for all by 2012, improve health outcomes, and slow health spending growth by $3 trillion by 2020. Central to the Commission's strategy is establishing a national insurance exchange that offers a choice of private plans and a new public plan, along with reforms to make coverage affordable, ensure patient access, and lower administrative costs.

Building on that foundation, the report recommends policies to change the way the nation pays for care, increase investments in information systems to improve quality and safety, and promote health. By stimulating competition among providers and promoting delivery system changes aimed at providing more effective and efficient care, the policies could yield higher value and substantial savings for families, businesses, and the public sector.

"To improve health and enhance our family and national security, we need to invest in substantial reforms," said Commonwealth Fund President Karen Davis. "With our economy in crisis, health costs squeezing family budgets, and coverage deteriorating, we can't afford to continue on our current path. The Commission has laid out a pragmatic strategy that could rapidly move us in more positive directions—if we start now."

Wal-Mart to Market Electronic Health Record System
Wal-Mart, the world's largest retail chain, announced this month that it will offer an electronic health record system to individual doctors and small physician practices. Most U.S. doctors work alone or in small groups, and many of them have been slow to adopt information technology because of its cost.

This move comes at a time of renewed interest in bringing physician practices into the digital era. The Obama administration's economic stimulus package includes $19 billion in incentives to encourage physician practices to invest in electronic health record systems.

Wal-Mart plans to offer a "package deal" for its electronic health record system, which would include hardware, software, installation, maintenance, and training. It will partner with Sam's Club, a division of Wal-Mart, to market the system; Dell will provide the computers and eClinicalWorks will provide the software.

The company maintains that its position as a high-volume marketer enables it to provide the technology at lower cost than its competitors. Wal-Mart's electronic health record system will cost less than $25,000 for one physician and about $10,000 for each additional physician in a practice. After installation and training, continuing annual costs for maintenance and support will be about $4,000 to $6,500 annually.

Pay-for-Performance Programs Make a Difference, Survey Finds
A recent survey of health plans found evidence that pay-for-performance programs (P4P) are improving the quality and efficiency of care. The survey—fielded by Med-Vantage, a health care software company, The Leapfrog Group, and the Integrated Healthcare Association, a health care improvement alliance based in California—includes responses from 75 sponsors of P4P programs (including individual health plans and coalitions) representing 150 million health plan members. This is the fourth time the survey has been conducted since 2004.

According to the findings, P4P programs have matured over the years. Most programs are more than five years old and have become integral parts of their sponsors' budgets (rather than one-time experiments). On average, P4P payments represent 7 percent of physicians' overall compensation and 4 percent of hospitals' overall compensation; in some programs, performance-based payments make up as much as 30 percent of physician compensation. P4P programs are also expanding in scope. Many current programs, for example, include greater numbers of physician specialties than in 2006, the survey's first year.

The most notable finding, however, is that P4P programs appear to be a having substantial impact on the quality of care. In the two years since the last survey, the percentage of programs that reported quality improvements related to performance payments nearly doubled. More than half of the programs reported measureable increases in clinical quality. P4P programs also reported advances in cost control measures, particularly the adoption of health information technology.

Patients Report Greater Satisfaction with Medical Practices
A Press-Ganey report found that patients' satisfaction with their medical practices rose in 2008, compared with 2007. The report synthesizes survey responses from nearly 2.4 million patients treated at 10,000 locations across the nation.

The authors attribute this increase to practices' efforts to solicit patients and meet their expectations. Practices are taking these steps because of the competition posed by walk-in clinics and the fact that payers are increasingly including patient satisfaction as a factor in their reimbursement. Patients, too, are able to use public reports and other resources to learn about and compare physicians and practices, choosing those that best meet their needs.

According to the report, patients' top priority in selecting a medical practice was the level of sensitivity shown by caregivers to patients' needs, followed by the overall cheerfulness of practices. The time spent waiting to be seen was also an important factor: the longer a patient has to wait, the lower their overall satisfaction.

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