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Sebelius Shines Spotlight on the 'Other Overhaul'—and on Peter Lee

By John Reichard, CQ HealthBeat Editor

October 4, 2010 -- It's what Health and Human Services Secretary (HHS) Kathleen Sebelius calls "the other health reform"—the overshadowed elements of the health care law that are designed to help government and business get better value for the health care dollar.

Early in the implementation of the law, the focus has been on adding new consumer protections for health plan enrollees, but the measure will also help spur a redesign of the health care system, she said.

Sebelius kicked off a daylong conference Monday, sponsored by her department and several lawmakers, by showcasing what she said is the fact that employers, hospitals, insurers and other groups have been working at the community level for years to build their services' value, with a number of successes. And she believes the law will help implement these successes more widely.

In her remarks Sebelius noted the recent appointment of Peter Lee as director of delivery system reform in the HHS Office of Health Reform. For many years Lee helped lead efforts by the Pacific Business Group on Health to help employers in California get better value for the health care dollar by putting pressure on local providers and health plans to report data on quality and efficiency of care to purchasers.

Sebelius wants to have Medicare and Medicaid become better "value purchasers," and she asserted that the law will help accomplish that goal with Lee playing a major part.

At the Pacific Business Group on Health, Lee "worked at systems changes along the way, and I think [he] is in the perfect place at the Department of Health and Human Services to help us figure out how to be good collaborators and partners and how to use the resources we have to help encourage the innovation that's taking place across the country," Sebelius told the forum, called the National Summit on Health Care Quality and Value.

"Our responsibility is to be guided by science, to look at what works and what doesn't—but also to closely examine those pockets of innovation across the country where we've seen great success and give support to bring those experiences to scale," Sebelius said.

The Pacific Business Group has led efforts to have private employers and government come to agreement on measures on quality care. For example, it helped developed instruments to rate the quality of individual doctors. "Approximately 17,000 physicians receive individual performance results based on 15 quality measures, using combined Medicare and commercial PPO data," the group notes on its website.

Pacific also boasts what it calls the first study of cost efficiency at California hospitals. Sebelius predicted that the work of appointees such as Lee and Donald M. Berwick, director of Centers for Medicare and Medicaid Services (CMS), would reap big dividends for system redesign efforts at HHS aimed at financially rewarding providers who deliver better quality and greater efficiency. Berwick "is always four or five steps ahead of everyone else" in seeing how the system can be redesigned and has the ability to clearly explain the system and how to achieve needed changes, Sebelius said.

Berwick was expected to address the event at the Capitol Visitor Center on Capitol Hill later in the day.

Conference participants were expected to hear about success stories in lowering costs by improving quality in systems such as Geisinger Health System in Pennsylvania; new models for improving the coordination of care at places such as the Everett Clinic in the state of Washington, and measurement of variations in the quality of care intended to find inefficient types of treatment.

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