Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.
Health insurers with the five largest enrollments nationwide—WellPoint, United, Aetna, Health Care Services Corp., and CIGNA—received a letter Monday from Senate Finance Committee Chairman Max Baucus (D-MT) and Senate Commerce Committee Chairman Jay Rockefeller (D-WV) asking them to explain their calculations behind "unnecessary" 2011 premium increases.
The chairmen are critical of reports that blamed some of these premium increases to coverage changes made through the Affordable Care Act (ACA). Their letter echoed concerns posed in a letter sent by Health and Human Services Secretary Kathleen Sebelius to health insurers earlier this month.
The chairmen said that they had called attention earlier to reports that some major insurers “radically increased profits and reserves" in 2009—some by over 25%. These increases were "clear indicators that insurance companies would not have to significantly increase rates for the next year," they said.
However, some insurers did seek double-digit increases in 2010—before the ACA was passed, they said. "This is irresponsible and unacceptable but is not, unfortunately, surprising," they said. "If an insurer thinks it can continue to impose double-digit premium increases, while providing fewer health benefits and enjoying record surpluses, it is again mistaken."
In 2011, they said, the ACA will require insurance companies to publicly justify premium increases that are deemed unreasonable and requires insurance companies to spend at least 80% of premium dollars on healthcare instead of administrative costs and overhead. By 2014, the ACA will give states and HHS the power to deny participation in insurance market exchanges to plans with a track record of unreasonable premium increases.
"We have and will continue to strongly encourage states and HHS to use their existing authority, as well as the authority created under the ACA to its fullest to ensure that premium increases across the country are justified and communications are honest," they note.
In a statement from America's Health Insurance Plans, press secretary Robert Zirkelbach said that "political attacks won't do anything to make coverage more affordable for working families and small businesses that are struggling in a slow economy.
Several key factors are combining to drive up premium costs, Zirkelbach says. These include price increases for medical services and plus greater use of expensive tests and procedures. In addition, younger and healthier individuals are dropping coverage due to the current economic conditions, meaning that health insurance risk pools are made up of older and less healthy individuals, he says.
And finally, the new healthcare reform law requires that health insurance coverage include a number of benefits that many policies previously did not cover. "Health plans will continue to do everything they can to implement the new law in a way that minimizes disruption and keeps coverage as affordable as possible for individuals, families and employers," Zirkelbach says.
Dispensing generic drugs rather than their brand-name counterparts reduced prescription drug costs in the Medicare Part D by $33 billion in one year, according to a studyby the Congressional Budget Office (CBO).
In 2007, the total payments to plans and pharmacies from the Part D program and its enrollees were about $60 billion, CBO said. The total number of prescriptions filled under Part D was about 1 billion—of which 65% were filled with generic drugs, 5% were filled with multiple-source brand-name drugs (which had generic versions), and 30% were filled with single-source brand-name drugs (for which no chemically equivalent generic versions were available).
Even though a majority of the prescriptions were filled with generic drugs, their lower prices meant that those prescriptions accounted for only 25% of total prescription drug costs. If no generics had been available, the total payments to plans and pharmacies from the Part D program and its enrollees would have been about $93 billion—or 55% higher.
The potential also exists to save even more through generics, according to CBO. Single-source brand-name drugs accounted for 68% of total prescription drug costs under Part D in 2007—even though the drugs accounted for only about 30% of actual prescriptions. Plans could have achieved some savings from that group of drugs by encouraging enrollees to switch to the generic forms of different drugs, the report said.
Over the next several years, entities that pay for prescription drugs will benefit from a wave of brand-name drugs in high-priced therapeutic classes losing patent protection—or other periods of exclusivity—that will allow generic drugs to enter those markets for the first time, CBO said.
If the current rate of generic substitution is maintained, first-time generic entry occurring through 2012 will generate about $14 billion in additional savings from generic substitution—in addition to the $33 billion in savings, it added.
The CBO report did note that spending under Part D on the category of drugs called biologics could to increase rapidly in the future. However, most biologics, which can run reach prices of tens of thousands of dollars per patient each year, are more likely to be covered under Part B of Medicare because they are injected or infused directly into the patient. Biologics accounted for only about 6% of total prescription drug costs under Part D in 2007.
The heat is being turned up on Medicare and Medicaid fraud this week with the release of new federal rules designed to detect fraud earlier and the introduction of proposed legislation that would strengthen the authority of the Department of Health and Human Services (HHS) to ban corporate executives from doing business with Medicare if they are convicted of fraud.
The new regulations, which will appear in the Sept. 23 Federal Register, would subject certain service providers and suppliers to fingerprinting, criminal background checks, unscheduled or unannounced visits, and stopped payments if credible fraud allegations are detected.
According to the new rules, service providers refer to healthcare entities that furnish services primarily payable under Medicare Part A, such as hospitals, home health agencies (including home health agencies providing services under Part B), hospices, and skilled nursing facilities. Suppliers include entities that furnish services primarily payable under Medicare Part B, such as independent diagnostic testing facilities, and durable medical equipment, prosthetics, and orthotics.
The new screening procedures would apply to newly enrolling providers and suppliers, including eligible professionals, beginning on March 23, 2011. The specific screenings would be performed based on the providers' or suppliers' level of risk--limited, moderate, or high. Limited refers to physician or non-physician practitioners and medical groups or clinics; moderate includes outpatient rehabilitation facilities and hospices; and high includes newly enrolling home health agencies or durable medical equipment suppliers.
The rules, which were proposed under the new healthcare reform law, are designed to reduce the estimated $55 billion in fraudulent or improper payments made annually by Medicare and Medicaid programs, according to administration officials.
In addition, House Ways and Means Health Subcommittee Chair Pete Stark (D-CA) and Rep. Wally Herger (R-CA), the panel's ranking member, introduced last week HR 6130, the Strengthening Medicare Anti-Fraud Measures Act. They were joined by 17 of their colleagues. The legislation expands the authority of the HHS' Office of Inspector General (OIG) to allow it to ban corporate executives from doing business with Medicare if their companies were convicted of fraud.
The measure also gives the OIG the ability to exclude from Medicare parent companies that may be committing fraud through shell companies. At a hearing on Medicare fraud in June, the chief counsel for the OIG asked members of the Ways and Means Committee for these changes.
"This legislation gives the Office of Inspector General the authority to go after crooked executives and corporations that continue to bilk Medicare," Stark said in a statement. Stopping these individuals "will save taxpayer money and protect Medicare beneficiaries," he said.
Health and Human Service Secretary Kathleen Sebelius announced on Friday that nearly $131 million in grants will be used to strengthen and expand the health professions workforce. The grants include $88.7 million in funding from the American Recovery and Reinvestment Act of 2009. Six areas are targeted under the grants:
Primary care workforce training.($42.1 million) The grants will support family medicine, general internal medicine, and general pediatrics programs, including curriculum development, faculty development, didactic and community?based education, and training in underserved areas for primary care residents, pre?doctoral students, interdisciplinary and inter?professional graduate students, and physician assistant students.
Oral health workforce training. ($24.9 million) Funding will target workforce development programs for pre- and post-doctoral training for dental residents; dental faculty; loan repayment for faculty who teach primary care dentistry; and training for practicing dentists, or other approved dental trainees in general, pediatric, and public health dentistry and dental hygiene programs.
Funding also includes $4 million to states to provide nine new grantees the opportunity to address their states' unique oral health workforce needs in underserved urban and rural areas. Grants are designed to strengthen the delivery of multidisciplinary comprehensive oral healthcare.
Equipment to enhance training across the health professions. ($50.5 million) Funding from the Recovery Act will provide 208 awards to assist with the purchase of equipment for training current and future health professionals across disciplines at the undergraduate, graduate, and post-graduate education levels. Awardees will include academic health centers, area health education centers, centers of excellence, and other educational institutions that serve underserved and uninsured patient populations, rural communities, and minorities.
Types of equipment to be purchased include: e-learning tools such as video, audio, and interactive learning systems to provide more distance-learning opportunities; human patient simulators to help students improve clinical judgment and critical thinking; and mobile dental vans to provide training care delivery to those who have been unable to access care.
Loan repayments for health professionals. ($8.3 million) The states will provide matching funds to 29 grants that are designed to assist health professionals in repaying their educational loans. In return, these individuals will agree to provide full?time primary health services in federal health professional shortage areas for a minimum of two years.
Those health professionals eligible to receive funding include physicians, dentists, nurse practitioners, nurse midwives, physician assistants, psychologists, and social workers.
Health careers opportunity programs for disadvantaged students. ($2.1 million) Three grantees will receive funding to increase diversity in the health professions by developing an educational pipeline to enhance the academic performance of economically and educationally disadvantaged students, and prepare them for careers in the health professions. Eligible applicants include schools of medicine, public health, dentistry, pharmacy, allied health, and graduate programs in behavioral or mental health.
Patient navigator outreach and chronic disease prevention in health disparity populations. ($3.8 million) Funding will support 10 grants for patient navigator outreach and chronic disease prevention programs to develop and operate patient navigator services that improve health care outcomes for individuals with cancer or other chronic diseases, with specific emphasis on health disparity populations.
"An adequate healthcare workforce is the linchpin for reforming our healthcare system to ensure greater access, improve the quality of healthcare and cut overall costs in the long term," Sebelius said in a statement.
More than $14.2 million will be used to develop, implement, and test strategies to improve the adoption and dissemination of interventions obtained from patient-centered outcomes research among racial and ethnic minority populations, Department of Health and Human Services (HHS) Assistant Secretary for Health Howard Koh, MD, MPH, announced Wednesday.
The National Institutes of Health (NIH) grant awards, made under its Comparative Effectiveness Research for Eliminating Disparities (CERED) program, will focus on issues such as breast and prostate cancer in underserved populations, cardio?metabolic issues in Native American and Pacific people, and health disparities in Harlem, NY.
NIH, with its National Institute for Minority Health and Health Disparities (NIMHD), awarded grants to centers of excellence at the following universities and medical schools: University of Alabama, Birmingham; University of South Florida, Tampa; University of Hawaii at Manoa; University of Illinois at Chicago; University of Michigan, Ann Arbor; University of New Mexico, Albuquerque; Mount Sinai School of Medicine of New York University; Columbia University Health Sciences, New York; and University of Puerto Rico, Medical Sciences, San Juan.
HHS' Office of Minority Health (OMH) also awarded nearly $2 million to Westat. This project will designate diabetes mellitus, cardiovascular disease (including stroke and hypertension), and arthritis as the primary health conditions for which appropriate interventions can be identified from comparative effectiveness research. Among the populations to be examined are African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and urban American Indians/Alaska Natives.
NIMHD and OMH will jointly evaluate the scientific progress of the recipients of the grant awards following standard NIH policies and procedures.
"Every citizen in our country deserves our best effort. With the help of the health information derived from these studies, we can take a step closer to achieving our goals and, at the same time, transform our communities into safer and healthier places for all people," said Garth Graham, MD, deputy assistant secretary for minority health and OMH director.
The awards are part of the investments made under the American Recovery and Reinvestment Act of 2009 (ARRA), which appropriated $1.1 billion to support patient-centered outcomes research. Of that total, $400 million was authorized to be allocated at the discretion of the HHS secretary for various patient-centered outcomes research and related activities.
The American College of Physicians, (ACP) in an updated paper released in July, noted that as the nation's population continues to grow and diversify, the healthcare system needs to change and adjust to meet the needs of an increasingly multicultural patient base.
While it has become standard practice in recent years for journal authors to disclose relationships with industry, the requirements have varied—leaving authors to determine the relevance of a financial relationship to a submitted article. As a result, disclosures have been inconsistent—even when the information could have been verified independently by the journals, researchers say in the latest Archives of Internal Medicine.
When researchers compared physician payment information from five orthopedic device companies with disclosure of company payments in journal articles in their study, they were able to find nondisclosed payments to 41 orthopedic surgeon researchers that ranged from just over $1 million to a high of $8.8 million. Of those authors, 32 published 151 articles between Jan. 1, 2008, and Jan. 15, 2009.
While almost all of the articles written by the surgeons were directly related to a device made by the company, none of the journal articles revealed how substantial those payments were that were made to the authors.
Whether the surgeons didn't disclose these details or whether the journals didn't publish the information is not known, says David Rothman, MD, president of the Institute on Medicine as a Profession (IMAP) at Columbia University, which conducted the Archives study. "We weren't pointing a finger at either surgeons or editors because we didn't know where [the nondisclosure] was."
However, the point of the study was to identify "the extraordinary lapse in the system" of revealing this data, says Rothman, who is also a professor and director of the Center for the Study of Society and Medicine at Columbia. The researchers obtained their data by reviewing 2007 physician payment data from five orthopedic device company sites to "evaluate the transparency provided by the current system."
While the new healthcare reform law will require all drug and device makers to report payments to physicians in a searchable public database by 2013, Rothman says it will not necessarily solve the problem unless journal editors use the information and physicians make full disclosures.
Using a top-down approach—by getting leading medical education institutions and the leading professional medical societies to really start emphasizing and using the data in and around conflict of interest—is one way "that this would be cost-effectively done" in the future, Rothman says.
Also, the emphasis on avoiding conflict-of-interest can start in the early years. "When I lecture medical students here at Columbia and talk about this subject, I tell them...[to] understand that from the very beginning, every dollar that [they] take—from a device or drug company—will be public information. It's a very different orientation," he says.
In a separate study on conflict-of-interest that appears this week in the Journal of the American Medical Association (JAMA), researchers found that some resident physicians rationalized that they were comfortable accepting gifts—because they had made sacrifices and they were "worthy of that treatment."
No physicians took any gifts in this study, said co-author, Sunita Sah, who is a former practicing physician who once consulted for pharmaceutical companies on sales and marketing to physician.
However, in their survey of 301 resident physicians, they found that "reminding physicians of sacrifices made in obtaining their education" resulted in gifts being evaluated as more acceptable: 21.7% in the control group vs. 47.5% in the group who "reminded" were more accepting of receiving gifts.
Financial self-interest may not "fully explain physicians’ acceptance of gifts," said the researchers from Carnegie-Mellon University in Pittsburgh. Rather, well-intentioned physicians may use rationalizations—subjective perceptions of hardships to accept "potentially biasing gifts."
Making conflict-of-interest disclosures is important to consumers, Rothman says, as evidenced bya recent Consumer Reports survey that found that nearly half of the patients questioned thought that gifts from pharmaceutical companies influenced their physicians' choices of medications.
But it's important as well to healthcare leaders. "What is certain is that colleagues need to know—whether you're making appointments to formulary committees, to lecture assignments, to medical students, or training residents or [making] decisions on publications," he says.
"It's a little bit of a pain in the neck" now to go to separate company sites to verify information, he says. While having an aggregated and more searchable site is still a few years off, Rothman advises: "Sure, trust your colleagues—but verify."
Prior to taking over as administrator of the Centers for Medicare & Medicaid Services (CMS) two months ago, Donald Berwick's name was fairly synonymous with the word "quality." The list of accomplishments for the founder, past president and CEO of the Institute for Healthcare Improvement have made him an international figure when it comes to examining the delivery of quality care. So the next big question is: what emphasis on quality improvement is he bringing to his new job?
Berwick made his first public speech this week to attendees at America's Health Insurance Plans (AHIP's) Medicare and Medicaid conference in Washington. Threaded throughout the talk—beyond examining the implementation of the Affordable Care Act—were references to quality and healthcare that will likely be highlighted during his term.
He said that "as we say in the world of quality improvement, 'Every system is perfectly designed to achieve exactly the results it gets.' If we want new results—and we do—we need a new system. All improvement is change." Here are some of those changes he is proposing.
The Triple Aim. To get started on his journey, Berwick referred to the roadmap that he would like to see "healthcare rally around"—"The Triple Aim"—which he first wrote about two years ago on how to improve care in the United States. The Triple Aim, he noted, refers to three goals at once:
Better care for individuals, as described by all six dimensions of quality in the 2001 Institute of Medicine report on Crossing the Quality Chasm: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity.
Better health for populations in relation to the upstream causes of ill health, such as poor nutrition, physical inactivity, substance abuse, and unwise behavioral choices, violence, and economic disparities.
Reducing per capita costs by eliminating waste.
For the last item, Berwick specified—in light of previous comments that have come under scrutiny—that this meant "not by withholding from us or our neighbors any care that helps them— specifically not by harming a hair on any patient's head."
Acute care. One of his "strategic priority" areas is to make "the quality of care in hospitals and outpatient clinical settings better—much better—everywhere and for everyone," Berwick said.
One of the top areas that he is focusing on: safety. He noted that the IOM's report on patient safety—To Err Is Human—is now over 10 years old. "We still lack the firm national commitment to make the safest care the standard care everywhere—no matter where an American patient goes," he said.
He called for a "rededication to safe care," with an aim for "a major and immediate reduction in medical injuries to patients in hospitals.
Integrated care. Substantial and prompt progress is needed toward better-integrated care—"care that makes sense to patients and families, so that they don't feel lost and forgotten and confused as they make their way through our complex systems," Berwick said. "We owe them journeys—not fragments."
Fragmented, disorganized care is still relatively common in today's healthcare system, he noted. It's where patients have to tell their name and address and story again and again to everyone you see, and where no one seems to talk to each other and records are forgotten or unavailable.
He cited the example of the fragmented car—one that would use the best of every vehicle—such as the brakes from a Jaguar, the door from a Volvo, the fuel system from a Camaro, or the suspension of a BMW.
But instead of the best car in the world, it would be a car that wouldn't work because the parts don't fit together. "A car isn't just a collection of parts; it is a system of interacting parts. That's why cars need designs, and that's why healthcare needs design, too," Berwick said. "'Everyone does their best" is a bad plan. The right plan is, 'Everyone does their best together.'"
Community-based prevention. Rather than wait for problems, actions should be taken to prevent them, Berwick said. That means addressing the causes of illness where they lie—in communities—by looking at daily habits, social supports, and everyday choices.
Moving in these directions will not work with a "top-down, national project," he said. Instead, any successful redesign of healthcare will be a community-by-community task. "That's technically and morally correct, because, in the end, each local community—and only each local community—has the knowledge and skills to define and deliver what is locally right."
America is "seriously underinvested" in using what is known about preventing illnesses such as heart disease, asthma, and depression, he said. "Prevention, if we get serious about it, is a big, big bargain."
So will this quality vision honed over years of working with healthcare providers work? "None of this will be easy." Berwick admitted. "All of us will have to change the way we do business. And there's plenty of work ahead."
To keep costs related to end-stage renal disease (ESRD) treatments down, Medicare will be bundling drugs and services for dialysis payments together beginning Jan. 1, 2011. Medicare, however, will find itself overpaying for the dialysis drugs because it is failing to take current market rates—which are dropping—into consideration, according to a report from the Health and Human Services' Office of Inspector General (OIG).
Currently, Medicare pays for most separately billable drugs furnished by independent and hospital-based dialysis facilities at 106% of their average sales prices. In 2008, Medicare paid $2.1 billion for separately billable ESRD drugs.
Starting Jan. 1, though, Medicare will base price updates on wage and price proxy data from the Bureau of Labor Statistics. For the ESRD drugs portion of the new bundled rate, CMS plans to use the producer price index (PPI) for prescription drugs to estimate price changes.
According to PPI data, prices for prescription drugs were 39% higher in the first quarter of 2009 than in 2003. However, the costs for the drugs that account for the majority of Medicare expenditures in independent dialysis facilities actually decreased during this same period.
In aggregate, drug acquisition costs at independent dialysis faculties in 2009 were 10% below the Medicare payment amounts. For these facilities, average acquisition costs for all 11 of the drugs under review were between 2% and 27% below Medicare payment amounts. The average acquisition cost for epoetin alfa—a product that accounted for nearly 70% of Medicare drug expenditures in independent facilities in 2008—was 9% less than the Medicare payment amount.
The OIG noted that if the PPI for prescription drugs had been an accurate predictor since 2003 for changes to acquire epoetin alfa, dialysis facilities would have paid $12.22 for 1,000 units of the drug in the first quarter of 2009. This amount would be 46% higher, though, than epoetin alfa's average acquisition cost among responding independent dialysis facilities. It was 33% higher than the ASP-based payment amount.
If the Medicare payment amount for epoetin alfa since 2003 were based on changes in the PPI, total program payments to all independent dialysis facilities for the drug in the first quarter of 2009 alone would have been $113 million higher than the actual payments.
Rep. Pete Stark (D-CA), chairman of the House Ways and Means Health Subcommittee, said in a statement that the U.S. must find the right payment levels that "preserve Medicare beneficiaries' access to quality care."
"Dialysis drug costs have dropped while the index the government will use to increase prices over time has risen," he said. "If these trends continue, the government will be overpaying for dialysis drugs. We must continue to carefully track drug cost and utilization trends for dialysis treatment."
The OIG recommended that the Centers for Medicare and Medicaid Services (CMS) develop a more "accurate method for estimating changes in the prices of ESRD drugs." However, CMS has responded that the "downward trajectory of average acquisition costs" shown in OIG's analysis was influenced by changes in CMS's payment mechanism for separately billable ESRD drugs, particularly for epoetin alfa.
While the historical average acquisition cost data presented in the OIG report may not necessarily "be predictive of future trends in the costs of separately billable drugs," the OIG said, it remained "concerned that Medicare could end up paying too much for these drugs" once the bundled rate is implemented—costing Medicare potentially hundreds of millions of dollars a year."
A health insurance premium tax credit that is part of the Patient Protection and Affordable Care Act (ACA) could assist more than 28.6 million Americans in purchasing healthcare coverage—even if they have pre-existing conditions, change jobs, or experience drops in income, according to astudy released Tuesday from Families USA. The value of the tax credits, slated to go into effect in 2014, is expected to be about $110.1 billion during the first year.
Individuals in working families—with annual incomes at or above 200% of the federal poverty level ($44,100 for a family of four in 2010)—will make up about two-thirds (65.6%) of those who will be eligible for a premium tax credit, according to the report, Lower Taxes, Lower Premiums: The New Health Insurance Tax Credit.
Overall, 95% of the people eligible for the new tax credit are going to be from "working families," the report noted. Specifically, 24.8 million of those eligible for the credits are from families with at least one worker who is employed full-time, while an additional 2.5 million people are in families with a worker who is employed part-time.
More than half of those who will be eligible for the premium tax credit will be working for small businesses with fewer than 100 workers (52.9%). About 15.2 million people will be in families in which a primary worker is employed by a business with fewer than 100 workers. Approximately 11.4 million people will be in families in which the primary worker is employed by a business with fewer than 25 workers.
The new tax credits will be providing individuals and families with tax relief—based on both their annual income and family size. For example, the tax credits would be available for four-person families with annual incomes (in current dollars) of up to $88,200; a three-person family would be eligible with incomes up to $73,240.
"This is one of the largest middle-income tax cuts in history," said Ron Pollack, executive director of Families USA, in a statement.
The tax credits will be provided on a sliding-scale. For example, a four-person family purchasing a $15,000 family insurance plan in 2014 with $60,000 in annual income would receive tax relief of approximating $10,200. A similar family with annual income of $35,000 would receive tax relief approximating $13,600.
When a person or family qualifies for a tax credit, the dollars from the credit will go directly into the health plan in which they are enrolled—offsetting the cost of the family's health premiums for that healthcare plan, according to the report.
The tax credits also will be advanceable: This means that families would not have to wait until their taxes have been filed and processed in order to receive the tax credit and enroll in coverage. They also would not have to pay the full premium cost at the time of enrollment—and then wait to be reimbursed
Families USA, a Washington, DC-based non-profit advocate for consumer health care has releasedstate-specific data about the number of people in each state who will be eligible for the tax credits and the amount of tax relief provided to families in that state in 2014.
In his first major speech since becoming head of the Centers for Medicare & Medicaid Services (CMS) two months ago, Donald Berwick, MD, on Monday urged insurers—along with employers, professional groups, and communities—to join together in advancing healthcare reform goals.
"All of us have to change the way we do business," he told attendees at the America's Health Insurance Plans (AHIP) conference on Medicare and Medicaid in Washington. "There's plenty of work ahead. I just know I can't do this alone. CMS can't do this alone. Government can't do this alone. We will either build a new healthcare system for our country together...or we're not going to build it at all."
But Berwick also emphasized--in what might considered a continuation of the tug-of-war relationship between CMS and AHIP over healthcare reform issues--that those who wish "only to preserve the status quo" are not going to be "constructive contributors to our nation's future."
Berwick's presentation before AHIP comes just a few days after his boss, Health and Human Services (HHS) Secretary Kathleen Sebelius sent a sternly worded letter to the trade group for some of its members "falsely blaming" the healthcare reform law for rate hikes for the upcoming year.
"It's a stark, clear reality that our healthcare system, in its current form, is not up to that job," Berwick said. "We cannot, with our current system of care, give Americans the care that they need and want and deserve."
As a way to pursue changes, Berwick said, "My door is wide open. It's open to the associations, delivery systems, professions, and other leaders who will join authentically in the pursuit of the 'Triple Aim' for America," he said in reference to an article he co-wrote two years ago in Health Affairs.
In that article, Dr. Berwick proposed a three part strategy to improve the experience of patient care, while addressing the population wide causes of disease and reducing per capita costs of healthcare.
To address population health, Berwick called for expanded prevention and treatment of diseases such as obesity and depression, along with more attention to underlying causes such as violence. Patients should no longer have to resubmit their personal information every time they go to a physician, and providers must better coordinate their care, he said.
On how to lower costs, he suggested "eliminating waste and needless hassles" though did not go into the specifics. Berwick did caution them against maintaining a system under which physicians were paid more if they did more.
As providers "find and adopt their own goals, CMS can help--and we will help--by adjusting payment methods to support that" and by making it "easier and easier for people to find best practices in neighborhoods and across the country," he said.
Karen Ignagni, AHIP's president and CEO, after Berwick's prepared comments said: "We intend to work with you to get it right."
