Managed Healthcare Executive - January 2009 - (Page 30)

MHE Resource Cost, quality, access not mutually exclusive THERE IS GROWING DEMAND for DUAL PRIORITIES: REDUCE COSTS AND EXPAND ACCESS health reform among the American public and the health industry itself, with great Which of the following healthcare reform issues would you most like pressure to reduce costs, expand coverage President-elect Obama to address his rst year in of ce? and improve quality of care. But, there are di erences in priorities, Reduce 51% healthcare explains Michael Thompson, principal, costs 25% PricewaterhouseCoopers (PwC) Health Industries. “The public wants PresidentExpand health 34% elect Obama to address the high cost of insurance care as his priority while health industry coverage for 61% the uninsured executives think his rst priority should be to expand coverage for the uninsured,” 15% Improve the Thompson says. overall quality of 14% Given the economic downturn, it is care provided not surprising that the public is focused on cost. At the same time, health industry American consumers Health industry in uencers executives know that one way to take cost Source: PwC/NACHRI Perspectives on Priorities: A Survey of American Consumers and Industry In uencers on Health Care Reform Under the Obama Administration out of the health system is to increase the number of people who have insurance. on either cost or quality.” dent-elect Obama’s campaign proposals The biggest surprise—or disappoint- to reform healthcare would cost approxiINTERRELATED TRIO ment—is that quality wasn’t cited as the mately $75 billion in 2009. Those costs When looking at the chart, however, it’s highest priority. The United States pays will increase signi cantly, to a cumulative important to realize that cost, quality and 47% more in healthcare per person each total of about $1 trillion by 2010. access are not mutually exclusive goals, say year than any other industrialized coun“We believe that the upward trajectory experts. try, yet it scores lower on many quality of federal spending overall is unsustain“They are interrelated and must be ad- measures. For example, medical errors able, and that funding the presidentdressed in a balanced way,” Thompson says. are the fourth-leading cause of death in elect’s health reform plan entirely with “There is a lot of excess waste in the cur- this country. new money is unlikely,” Thompson says. rent system, and eliminating such waste can “Right now, we have a toxic nancing “About one-third of the required federal help to pay for increased coverage. Yet we system that does not reward quality,” he spending on health reform already exists also know that focusing only on cost con- says. “From the perspective of reimburse- and could be reallocated. Currently, this tainment can create misaligned incentives ment, the optimal system is one that is money largely goes to hospitals to comaround quality. Reimbursement models, based solely on providing the best possible pensate for free care.” incentives and strategic cost reduction must outcome for patients and the community. The president-elect also has proposed not come at the expense of quality.” From a revenue perspective, the health signi cant investments in IT. “That will TriZetto’s Larry Bridge, senior vice organizations that will thrive in the future ensure that the health system is supportpresident of payer markets, agrees that cost, will be those that create the greatest value ed by a digital backbone that enables inquality and access are all interrelated. for patients.” teroperability,” Thompson says. “There “It is easy for most people to jump De ning appropriate treatment for the is also increased emphasis on research on on the cost aspect since it is the most most common disease states and retooling comparative e ectiveness, movement tovisible part of the problem,” Bridge says. health bene t plans and provider com- ward prevention and wellness, as well as “It is only when you really examine the pensation to encourage treatment with redesign of provider reimbursement away issue that you begin to understand that evidence-based medicine guidelines will from volume-based to being more valueif we don’t nd a way to provide cover- play an important role in improving cost based.” MHE age to the uninsured, it becomes almost and quality, Bridge says. —Tracey Walker impossible to have a meaningful impact According to PwC’s analysis, PresiCommentary is independent of source data 30 JANUARY 2009

Table of Contents Feed for the Digital Edition of Managed Healthcare Executive - January 2009

Managed Healthcare Executive - January 2009 Contents Editorial Advisors For Your Benefit News Analysis Politics & Policy Letter of the Law Managed Care Outlook New Day 5 New Realities of Disease Management Pharmacy Best Practices Health Management Technology State Report: Hawaii MHE Resource Ad/Edit Index

Managed Healthcare Executive - January 2009

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