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The Essential Work of Defining Essential Healthcare Benefits

Margaret Dick Tocknell, for HealthLeaders Media, October 5, 2011

Applying evidence to benefit coverage. Stakeholder comments to the IOM committee were united in support of using medical evidence to decide what benefits should be covered in an essential healthcare package. But what evidence should be standardized? Should there be flexibility so as not to limit access to care? How should evidence be used to assess new technologies? Age and chronic illnesses also come into play. The IOM has it hands full here.

I asked a few stakeholder groups what they would like to see from the IOM’s review.

Ethan Rome, executive director of Health Care for America Now, a grassroots group affiliated with the Obama administration’s healthcare reform efforts, says a specific list of essential medical benefits would be a bad idea. “The final rules must ensure that consumers get good benefits, not mini-med plans that burden families and businesses with outrageous medical costs and force them into bankruptcy,” he told HealthLeaders Media.

Dave Lemmon, director of communications for Families USA, a nonprofit advocating for consumers, says the organization would like an essential benefits package to “recognize the importance of coverage for disease management services that can help people stay healthy, save money, and avoid more expensive interventions.”

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1 comments on "The Essential Work of Defining Essential Healthcare Benefits"


Matthew Bassett (10/7/2011 at 4:37 PM)
You were spot on when pointing out that the devil is in the details. The White House will carefully watch the response to the IOM report which will likely not satisfy anyone and only raise politically difficult questions. HHS is already saying that the final rule will not be out until May of next year at the earliest. This would be in the heat of the Presidential election and right around when the Supreme Court could rule on the constitutionality of the ACA. No one should be surprised if this is not settled definitely until after the election. At least this means that providers have time to express their views to state and federal officials. Payors' views are already well established and it seems the provider community is very late to the game. Providers need to make their voices heard now to help shape this important rule. Matthew Bassett, Revive PR