Report endorses bundled care

Brookings report endorses coordinated, bundled care

A new report from the Brookings Institution offers a framework for person-centered care that provides sustainable lowered costs and promotes higher quality care.

The report, “Person-Centered Health Care Reform: A Framework for Improving Care and Slowing Health Care Cost Growth,” is the third in the Brookings Institution’s Engelberg Center for Health Care Reform’s “Bending the Curve” series.

[See also: Bipartisan Rx plan for healthcare]

The report was authored by 18 experts in their fields, including former U.S. Senate Majority Leader Tom Daschle; Michael Leavitt, former governor of Utah and former secretary of the Department of Health & Human Services; and Mark McClellan, MD, director of the Engelberg Center, all of whom presented the report during a press conference April 30.

The report, McClellan said in his opening remarks, “is not the usual list of cost-cutting measures. It is a framework that can be implemented starting now to put the focus in healthcare much more squarely on better, higher-value care for each person by supporting innovative changes in Medicare, Medicaid and private insurance. Our framework enables cost savings by moving our policies to support better quality care that drives reform.”

While the report provides guidance on how policy-makers can move forward to a sustainable economic future for healthcare and ensure quality care, the changes recommended will not be easy, Daschle cautioned.

The report is centered around four components that Democrats and Republicans agreed were important, said Leavitt:

  1. integrated care is better than uncoordinated care;
  2. movement must be away from the fee-for-service system toward a risk-based payment system;
  3. the need to preserve quality of choice for consumers; and
  4. savings must be “scoreable” for lawmakers.

Among the report's recommendations:

  • Transitioning from Medicare’s traditional fee-for-service model to a proposed Medicare Comprehensive Care model in which teams of providers deliver coordinated care and receive one payment for the entire scope of services.
  • Transitioning Medicaid from a state-by-state waiver program to a financial system tied to better care and lower cost growth on a per-beneficiary basis. The new system would allow states to have more opportunity to share in cost savings.
  • Limiting the tax exclusion of employer-provided health insurance benefits by imposing a cap on federal subsidies that would grow at the same per capita rate as those in Medicare or the exchanges.
  • Improving cost and quality transparency by, among other things, restricting “gag” clauses.
  • Updating antitrust enforcement guidelines that would place more emphasis on clinical integration tied to financing reforms in such a way as to place providers at financial risk for higher costs.

If these recommendations are rolled out incrementally over the next decade, the report authors estimate that the country could save $300 billion or more and long-term savings could exceed $1 trillion over 20 years. More important, Leavitt noted, the recommendations offer a framework that keeps per capita cost growth more in line with per capita growth in the gross domestic product.