By David Pittman, Washington Correspondent, MedPage Today
Published: March 13, 2013
WASHINGTON -- To slow down growth in health spending, health insurers could employ the same strategy Medicare used a decade ago to increase use of generic drugs, a former Medicare czar said.
Medicare's prescription drug benefit created tiers of products, with much higher copays for brand-name drugs compared with their generic counterparts. As a result, seniors accelerated their use of the lower-cost generics and caused Medicare Part D spending to be much less than initially anticipated. Today, generics account for about 80% of all drugs dispensed.
"What we haven't seen is that kind of approach hitting the rest of our healthcare system in any big way," said Mark McClellan, MD, PhD, who ran the Centers for Medicare and Medicaid Services (CMS) when Part D was implemented in the middle of the last decade. But he added that such changes are starting to occur.
For example, grocery store chain Safeway gathered data from gastroenterologists near its corporate headquarters in Northern California to help employees really figure out what services they were paying for with a colonoscopy. There was nearly a 25-fold variation in costs among providers.
McClellan said the grocer redesigned its benefit program with the information and basically gave free colonoscopies to employees who used the lower-cost providers. Use went up and employees switched to the less expensive providers. "It led to a huge savings in cost," he said, adding that policymakers and private insurers could use the same techniques as Part D and Safeway.
"I do think there's some real opportunities for bipartisan support around legislation that's not about shifting costs to seniors, but instead gives seniors the opportunity -- or other Americans the opportunity -- to save more money when they get the care they need at a lower cost," McClellan said here Tuesday at the American Cancer Society's National Forum on the Future of Health Care.
Comparable data on the quality of services doesn't exist for medical procedures and care as it does for brand and generic drugs, said McClellan, who is director of the Engelberg Center for Health Care Reform at the Brookings Institution here. He admitted there's a lot of apprehension around giving patients accountability because high-risk on patients could be worse off as they could end up with poor outcomes through no fault of their own.
Delivery system models like accountable care organizations (ACOs) are a step in the right direction in the meantime, McClellan said. However, ACOs should be a second track alongside fee-for-service while organizations start tracking cost and quality data. Over time, data and payment incentives will be refined and implemented.
"With better measures of what really matters for patients in our healthcare system, it's possible to implement the kind of financing and regulatory reforms that get to alignment between what we want for patients in terms of care delivery and emphasis on the patient experience, and our healthcare policies," McClellan said.
The current fee-for-service model does not support many of the programs that help improve care delivery, such as coordinated care teams and after-hours care, McClellan said. Instead, those efforts aren't paid for and providers get paid less if their care leads to fewer patient visits.
ACOs, bundled payments, and patient-centered medical homes should be viewed as part of a comprehensive strategy to move away from fee-for-service, he noted.
"What I haven't seen yet at the federal level is a systematic approach to say we are going toward achieving better results at lower cost, and here's a systematic strategy for the things we're going to measure," McClellan said. "And we're going to get on that patch."
Like many others in Washington, McClellan noted now is the time for Congress to repeal Medicare's wildly unpopular sustainable growth rate (SGR) formula which determines physician payments. Lawmakers are pushing for action as the estimated price of repealing the program has dropped to $138 billion; they want to repeal the SGR and replace it with a system that better rewards quality and efficiency.ign Up
David Pittman is MedPage Today’s Washington Correspondent, following the intersection of policy and healthcare. He covers Congress, FDA, and other health agencies in Washington, as well as major healthcare events. David holds bachelors’ degrees in journalism and chemistry from the University of Georgia and previously worked at the Amarillo Globe-News in Texas, Chemical & Engineering News and most recently FDAnews.
http://www.medpagetoday.com/PublicHealthPolicy/Washington-Watch/37865?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2013-03-14&eun=g350341d0r&userid=350341&email=john@thebrokerageinc.com&mu_id=5344066
No comments:
Post a Comment