On May 23, the Senate Finance Committee held a hearing,
Progress in Health Care Delivery: Innovations from the Field, to hear testimony on new developments in health care delivery system reform in the wake of the Patient Protection and Affordable Care Act (PPACA).
Committee Chairman Max Baucus (D-MT), in
his introductory statement, said that the hearing would examine the ways in which delivery system innovation helps to reduce health care costs and improve health care quality. “The private sector has always been at the forefront creating innovative ideas,” Baucus said, though he noted that “the private sector cannot do it alone, nor can Medicare and Medicaid. The only path forward is through partnerships between the public and private sectors.” Baucus cited the Center for Medicare and Medicaid Services (CMS) Innovation Center – which identifies, develops, supports, and evaluates innovative models of payment and care service delivery for Medicare and Medicaid– as a positive step initiated by PPACA.
The committee’s ranking Republican member, Orrin Hatch (R-UT), in
his opening statement, criticized PPACA in general and the CMS Innovation Center specifically, noting that the program “has an enormous budget and very little accountability.” He also noted that the standard fee-for-service payment system “provides little financial incentive to manage care properly. Instead, the incentive is to increase the volume of services. Reducing costs will require that patients receive the right care, in the right place, at the right time. Increasingly, it is private payers — on behalf of employers — who pressure providers to reduce costs, providing better care and better health outcomes.”
The committee heard testimony from the following private-sector health care insurer and provider representatives:
- Dr. Richard Migliori, executive vice president of health services at UnitedHealth Group, recounted his organization’s efforts to increase access to high-quality, affordable care by embracing wellness and prevention programs, providing individuals with tools and transparency to make better decisions, and instituting payment reform to better align incentives with quality outcomes. “public-private collaboration on delivery system reform will produce better results for the American people,” he said.
- Dr. Lee Sacks, chief medical officer for Advocate Health Care and CEO for Advocate Physician Partners (Oak Brook, IL), described his organization’s Clinical Integration Program, an accountable care organization (ACO) that allows payers, patients, physicians and hospitals to collaborate on health care efforts. Such collaborations “have the ability to …drive significant improvements in health outcomes and the patient experience while also reducing costs,” he said.
- Marc Malloy, president and CEO of Renaissance Medical Management Company (Wayne, PA), talked about his organization’s experience as a “pioneer” ACO selected by the CMS Innovation Center. He cited three primary areas of focus for improving quality and lowering costs: prevention and wellness efforts, screening and intervention for health risk factors and coordinated, evidence-based care by a physician team.
- Paul Diaz, president and CEO of Kindred Healthcare, Inc. (Louisville, KY), discussed his organization’s efforts to provide clinical integration between acute and post-acute care and between post-acute providers. He also emphasized “the need for collaboration, trust and teamwork between providers, payers, and policymakers to achieve delivery system reform,” noting that the ability to achieve immediate results “will depend critically on some measure of payment stability and confidence in the short-term and incremental reform of our current payment system.”
