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Healthcare Reform an Insider's Game Now

 |  By Margaret@example.com  
   February 01, 2012

In a strategic move, President Obama devoted fewer than 100 words to healthcare reform in his State of the Union address. In the most recent GOP candidates' debate, Mitt Romney denounced the Affordable Care Act. But in the same breath he defended the healthcare reform that he enacted as Governor of Massachusetts.

In this election year, the complexity of delivering quality care at a lower cost has been reduced to tightly controlled messaging by the President and his political opponents.

Elsewhere in Washington recently, at the Centers for Medicare & Medicaid Services' day-long care innovation summit, attendees and speakers reveled in the possibilities of more pliable cost curves and incentives for better care.

An estimated 1,000 medical professionals, academic and policy wonks, and investors gathered for the summit, which featured key players from CMS' Center for Medicare and Medicaid Innovation, as well as popular healthcare speakers such as Dr. Atul Gawande.

I was still wondering about the SOTU address while I watched a couple of hours of the summit on my computer. As I listened to talk about performance payments, hospital readmissions, bending the cost-curve, and kicking up our innovation mojo, it occurred to me that the president might have been right to soft-pedal any mention of healthcare reform. It's more of an insider's game now. And I don't mean that in a negative way.

Healthcare reform has moved well past the point where mere mention of the reduction of the donut hole or elimination of pre-existing clauses in insurance policies can elicit a round of applause. For now, to the average Joe, healthcare reform is like sausage making. He doesn't want to know the details of what goes into it; he's just hungry for the results.

Take for example the infamous triple aim: better care, better health, lower cost. It's a clever six-word summary of healthcare reform, but actually getting there involves a journey into a complex world of quality measures, shared savings, bundled payments, etc.

Case in point: On the morning of the summit, CMS released an eight-page report, "One Year of Innovation," which details how the agency will spend more than $1 billion on initiatives it hopes will achieve the triple aim.

Here's a sampling of innovation initiatives it's promoting: the Innovation Advisors Program, the Multi-payer Advanced Primary Care Practice Demonstration, State Demonstrations to Integrate Care for Medicare-Medicaid Enrollees, and the Financial Alignment Model Demonstrations.

Talk about sausage making! Eventually some of these projects may produce results that help achieve the triple aim, but it's not likely that the average healthcare consumer will ever connect the dots between any of them and the care received in a doctor's office or at a hospital.

Atul Gawande, the Boston surgeon and author, probably captured the state of things best in his keynote speech at the summit. "We have been engaged in this battle over whether the problem is bureaucracy and government; whether the problem is business and insurance hassles. I can tell you as a physician that all of these things make it harder day-to-day to get the job done."

"But, they are only symptoms of the deeper, more vexing problems you really think about day-to-day as you are seeing patients, and that is the complexity of what it is to actually deliver good care. The innovations we're thinking about are really most deeply rooted in understanding how we handle the complexity."

Politicians may rail against healthcare reform, or opt to soft-pedal the issue, but it doesn't really matter to industry insiders. They work with ideas, not sound bites.

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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