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Panel Offers Array of Suggestions to Overhaul U.S. Health System

By Leah Nylen, CQ Staff

November 3, 2008 -- The Center for American Progress has some suggestions for the next president on a health care overhaul: Change the payment system to encourage more doctors to study primary care and promote greater care coordination.

While several health groups have released blueprints or white papers on a potential overhaul, the Center for American Progress could have some sway over a future administration should Democratic candidate Barack Obama win the presidency: The center's president, John Podesta, an Obama adviser, will head up the Illinois senator's transition team.

More than a dozen health experts contributed to the 110-page report, which was published in conjunction with the Institute on Medicine as a Profession at Columbia University.

Each the six chapters offers recommendations on aspects of a potential overhaul, including changes to the infrastructure and organization of health care delivery as well as quality of care and payment incentives.

"We are in desperate need for federal leadership," said David Rothman, the director of the institute. "Real progress is going to require federal commitments."

At Friday's forum, the authors emphasized the need for change to the Medicare payment system, arguing that private insurers will follow Medicare's lead.

"The effect of the [current] payment system dramatically undervalues primary care," said Paul Ginsburg, president of the Center for Studying Health System Change and primary author of the chapter on payment incentives.

Ginsburg said Medicare should revamp its payment system to better reflect the cost of delivering the service. He also advocated moving away from the "fee-for-service" model and instituting policies that promote greater care coordination, such as capitation payments for management of chronic conditions.

Other authors, including Robert Berenson, a senior fellow at the Urban Institute, noted that the country may soon find itself with a shortage of doctors trained in the fields of primary care and geriatrics because those areas tend to pay less.

"We are going to have a real problem in access to care," Berenson said. "Next year Congress has to deal with reimbursement."

Congress could consider increasing reimbursements or offering funding for programs such as the National Health Service Corps that offer loan repayment, he said. But an even more innovative approach would be for Congress to create new pay models that promote changes in medical organization, such as multispecialty group practices, according to Berenson.

Other authors focused on the importance of providing information to ensure quality of care. Chiquita Brooks-LaSure, a staff member on the House Ways and Means Committee and a former director of Avalere Health, said Congress should look into ways to incorporate new technologies, such as health information technology and comparative effectiveness research.

Katherine Hayes, vice president of health policy at Jennings Policy Strategies Inc., encouraged the adoption of chronic disease self-management programs. These programs are designed to teach patients how to better manage their illnesses, since the majority of care related to chronic diseases occurs at home. Hayes suggested that Medicare also could change reimbursement rates and also could promote the adoption of self-management programs.

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