"These metrics are not enough. Reforms must also be evaluated on how they affect the risk of potentially high expenditures to which beneficiaries are exposed–striking a better balance between financial protections on the one hand and preserving incentives to consume care wisely on the other."
Baicker warned that cost-sharing that ignores the differences in health benefits produced by different types of care, could reduce the use of highly effective care as much as it reduces use of low-value care.
A better approach, she suggested, is value-based cost sharing where services of high value would come with little or no cost sharing. Cost sharing "should be ratcheted up depending on how the value of care diminishes. Care that delivers very little benefit for seniors should come with a substantial copayment."
Although the committee hearing ended without taking action on the recommendations, there was general agreement that a consensus is beginning to build around these proposals.
Still, Patricia Neuman cautioned that the committee has "set a high bar" if it hopes to restructure the Medicare benefit design to provide catastrophic protection, streamline benefits, nudge beneficiaries toward higher-value services, strengthen financial protections for low-income beneficiaries, maintain the average value of benefits, and produce Medicare savings. "Achieving all of these goals simultaneously is a challenge."