Candidate Barack Obama's campaign proposal to cover America's 45 million adults without health insurance seemed straightforward, says Sg2 Political Analyst James Bradford: offer subsidies for the poor to buy insurance or create a government-administered option available to the uninsured. But for President Obama and Congress, the devil has been in the details, Bradford says, and a new plan to allow formation of healthcare cooperatives may help shore up the foundering health reform bill.

After an outcry from dozens of senior citizens, Bristol (CT) Hospital and the city announced that they will reopen the small medical clinic they shut down. A deal worked out between the hospital and the city will bring back the most commonly used medical services, but on a restricted schedule and with a higher cost to seniors.

Pressed by industry lobbyists, White House officials have assured drug makers that the administration stood by a behind-the-scenes deal to block any Congressional effort to extract cost savings from them beyond an agreed-upon $80 billion. Drug industry lobbyists reacted with alarm to a House healthcare overhaul measure that would allow the government to negotiate drug prices and demand additional rebates from drug manufacturers. In response, the industry successfully demanded that the White House explicitly acknowledge for the first time that it had committed to protect drug makers from bearing further costs in the overhaul.

Current healthcare reform efforts under consideration in Congress—ranging from payment reforms (such as episode payments and accountable care organizations) to efforts to promote implementation of health information technology—have at least one thing in common, according to Mark McClellan, MD, director of the Engelberg Center for Health Care Reform at the Brookings Institution in Washington, DC.

"We can't do any of them without reliable, meaningful, and consistent measures of quality being available," McClellan said recently at a "Getting to a High-Value Health System" meeting in Washington. That means now is the time to "get systems in place to support better decisions for patients by their clinicians involved in their care, and by everyone who is working at the personal level to improve care."

The High-Value Health Care concept is a project of the Quality Alliance Steering Committee, made up of the Engelberg Center, the Robert Wood Johnson Foundation, the American Board of Medical Specialties, and America's Health Insurance Plans. The idea is that little attention has been directed to the questions: What reform is needed to ensure that needed quality measures are implemented quickly and efficiently, and how can the measures be used to improve healthcare?

Getting to better quality healthcare will take some time, According to Carolyn Clancy, MD, head of the Agency for Healthcare Research and Quality, quality is moving in the "right" direction. She said at the current rate, "it will take 18.73 years to close the gap between best possible and actual care," she said at the meeting. "So we've got a long way to go."

To move toward a healthcare system that better measures and reports on quality and costs consistently across the country, the steering committee has introduced a three-year plan to advance this idea. Among the goals are:

• Meeting the need for a "virtual infrastructure" for quality and cost measures


• Creating a seamless data collection and reporting infrastructure


• Advancing a model for electronic base data sharing to improve care


• Developing a national infrastructure

McClellan emphasized that the focus was not just on quality reporting. "It really should be a consistent outgrowth of all the other steps we're taking over the next few years to improve care," he said. For example, health information technology payment incentives to providers can be "a powerful force" to produce quality measures.

The Office of the National Coordinator for HIT, working with AHRQ, has emphasized that the "meaningful use of health IT" relates to improving healthcare. "It's not just focusing on certification of systems, but actually getting information using those systems [to] document where the gaps are," he said.

Those HIT systems can help providers and patients improve their care," McClellan added. "At the same time, that can be a basis for quality measures that show that the HIT system …is actually having an impact."