Thursday, May 29, 2008

AHP Announces a Health Care Reform Initiative and Tells All of the Other Stakeholders What They Ought to Do

I'd like to propose a new health care reform rule.

You can't announce health care reform proposals unless Part 1 of your plan first tells us just what it is your side is going to sacrifice for the effort.

I don't know about you, but I am getting tired of one vested interest after another in the health care system telling the others what it is they have to do to fix the system. Everyone has to sacrifice to fix the system and each side should start by outlining what it is they are throwing in the pot before they get to play.

Last December, the health insurance industry trade association, AHP announced its plan for ensuring everyone has access to a health insurance plan even if they have a preexisting condition:
Under this plan, states should establish Guarantee Access Plans to provide coverage for uninsured individuals with the highest expected medical costs. If an individual is not eligible for coverage through the Guarantee Access Plan, health plans would then provide coverage to that individual on a guarantee issue basis with premiums capped at one-and-one-half times the standard rate.
AHP's idea for making sure everyone has health insurance is to take the healthy ones and leave the sick to the states.

Today, they announced a cost containment plan. They talked a lot about what others need to do but I didn't see a lot aimed specifically at what insurers are willing to sacrifice to bring costs down.

Here are AHP's five principles from their "Proposal to Reduce Health Care Costs:"
  • Principle #1: Patients and their doctors must have the information and tools they need to evaluate treatment options and make health care decisions on the basis of safety, quality and cost.

AHIP Proposal: Access to information that compares the effectiveness and cost of treatments: Give providers, patients and purchasers access to a trusted source where they can find up-to-date and objective information on which health care services are most effective and provide the best value.

  • Principle #2: Patients and doctors want an efficient, interconnected health care delivery system that reduces medical errors.

AHIP Proposal: Health information technology: Encourage widespread adoption of tools such as electronic health records (EHRs), personal health records (PHRs), secure e-visits with physicians, and e-prescribing.

  • Principle #3: Doctors and nurses need the freedom to practice medicine without worrying about frivolous lawsuits.

AHIP Proposal: Reforming the legal system: Replace the current medical liability system with a dispute resolution process consisting of an objective, independent administrative process to provide quick and fair resolution to disputes while promoting evidence-based medicine.

  • Principle #4: Health insurance plans are transitioning to a system that more closely aligns payments with the quality of care patients receive.

AHIP Proposal: Build health care reform around quality improvement by rewarding safety, value and effectiveness: Work for the broader adoption of value-based reimbursement mechanisms and provide consumers with more actionable information about health care value.

  • Principle #5: The nation must move towards a system of care that focuses on keeping people healthy, detects disease at the earliest possible stage and rewards chronic care management.

AHIP Proposal: Enhanced disease management, care coordination and prevention programs: Deploy a new generation of strategies that emphasize prevention, improve chronic care and tailor healthcare for patients to help them live longer and stay healthier.

There's nothing wrong with their five principals. They are, perhaps with the exception of legal reform, fairly non-controversial--at least til you get into the details. They are also incremental since much of this is going on in the market anyway.

AHP says that fully implemented our health care expenditures could be $145 billion less than they would have been in 2015 without these things. Since we're already over $2 trillion and likely headed to more than $3 trillion in the next seven years at this rate, that would be a savings of 3% to 5% of overall 2015 costs. Big money at one level but hardly a rounding error in the overall scheme of things.

It's hard to understand why AHP sees that kind of savings as a big deal. One has to believe a whole lot of bad things would already have happened to America's health care system--and maybe the private health insurance business--well before the $3 trillion mark.

And I don't think state run risk pools will help their cause a lot either.

It's going to take a lot more than this to fix the system and a lot more sacrifice.


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