Senate Finance Holds First Roundtable On Health Care Reform

Today the Senate Finance Committee held the first of three scheduled roundtable discussions on health reform. The first topic area considered was delivery system reform. The second roundtable will address coverage expansion and will be held on May 5. The third and final roundtable on financing will take place on May 14. Committee walk-throughs of tentative legislation will follow each roundtable with a mark-up expected in June.

After brief opening remarks from Senator Max Baucus and Senator Charles Grassley, the roundtable discussion began and was moderated by John Iglehart, founding editor of Health Affairs.

The major themes of the delivery system reform discussion were:

- Discussion of integrated systems like Geisinger Health System and tested care coordination models for adults with chronic conditions (such as the Advance Practice Nurse Transitional Care Model)

- Reforms of current payment system including bonus payments for primary care physicians, bundling of payments, revise process for setting relative values in Medicare, paying for outcomes

- Reform CMS to remove silos; should be a source of innovation and the best place in government to work; less prescriptive legislation with latitude to make decisions, subject to proper oversight; ability to implement successful pilots and demonstrations more quickly without having to seek additional authorization; public-private partnerships; leverage Medicare and Medicaid

- Health IT: electronic medical records, use data to educate providers about how they compare to their peers (e.g., hospital readmission data)

- Workforce: increase use of advance practice nurses, overcome barriers that prevent academic medical centers from valuing primary care as a specialty; possibly create commission to study workforce shortage and make recommendations to Congress

- Patient-centered model; medical home

-Individual choice, supported with information so that patients can make informed, evidence based choice; importance of comparative effectiveness research; provide incentives for patients to make healthy choices (Safeway example: financial incentives to lose weight, quite smoking)

- Importance of care coordination and availability of home and community based services (Washington state was the example cited and discussed by Senator Cantwell and Mark McClellan as a model that could save billions if implemented nationwide)

- Prevention of fraud and abuse: scrutinize providers and suppliers before enrollment; establish payment methodologies that are reasonable and reflect the marketplace; require compliance plans; vigilant monitoring (better data systems); respond quickly to detected fraud

The participants in today’s roundtable are listed below. Their written statements may be access at http://finance.senate.gov/sitepages/hearing042109.htm:

Allan M. Korn, M.D., Senior Vice President, Chief Medical Officer, Office of Clinical Affairs, Blue Cross Blue Shield Association, Washington, DC

Glenn M. Hackbarth, J.D., Chairman, Medicare Payment Advisory Commission, Washington, DC

Peter V. Lee, J.D., Executive Director, National Health Policy, Pacific Business Group on Health, San Francisco, CA

Mark B. McClellan, M.D., Director, Engelberg Center for Health Care Reform, Brookings Institute, Washington, DC

Lewis Morris, J.D., Chief Counsel to the Inspector General, Office of Counsel to the Inspector General, Washington, DC

Mary D. Naylor, Ph.D., FAAN, RN, Marian S. Ware Professor in Gerontology, University of Pennsylvania School of Nursing, Philadelphia, PA

Debra Ness, President, National Partnership for Women and Families, Washington, DC

Frank G. Opelka, M.D., FACS, Vice Chancellor for Clinical Affairs, Professor of Surgery, Office of the Chancellor, Louisiana State University, Health Science Center, New Orleans, LA

Glenn Steele Jr., M.D., PhD, President, Geisinger Health System, Danville, PA

John Tooker, M.D., MBA, FACP, Executive Vice President/Chief Executive Officer, American College of Physicians, Philadelphia, PA

Richard J. Umbdenstock, FACHE, President and CEO, American Hospital Association, Washington, DC

Ron Williams, Chairman and CEO, Aetna Inc., Hartford, CT

Paul J. Diaz, J.D., President and CEO, Kindred Healthcare Inc., Louisville, KY