After the Supreme Court Decision: Full Speed Ahead

A panoply of high-profile health policy leaders, running the gamut from constitutional experts to health plan executives, from academics to state Medicaid directors, gathered in Washington earlier this week for a conversation about the path ahead for health care reform. The event, “After the Supreme Court: Moving Ahead to Implement the Affordable Care Act, Improve Health and Health Care and Lower Costs” was organized by Health Affairs, the nationally-recognized health policy journal. While the speakers incorporated a range of perspectives on the intricacies of the law’s implementation, they also addressed broader concerns about health care delivery and impending changes in the health care marketplace. Several themes, including affordability, collaboration and accountability emerged as “must-do’s” for a changing health care system.

Remarkably, in this period of intensely partisan rhetoric, two former administrators of CMS, Dr. Mark McClellan and Dr. Don Berwick, the former a Republican, the latter a Democrat, served as the conference co-chairs. They framed the discussion around a few core issues: the imperative of lower costs and the need for payment reforms; shifts to systemic approaches in health care delivery that  center on what the patient needs; stronger collaboration between the federal government and states;  and the need to assure safety net coverage for those who can’t afford care.

Speaking as part of a panel on “The Urgency of Attacking Costs and Improving Care,” Dr. Michael Cropp, president and CEO of Independent Health in Buffalo, New York and vice-chair of ACHP’s Board of Directors, pointed to what he termed “individual agency” – the recognition that sweeping systemic problems can only be addressed if all stakeholders acknowledge their roles and responsibilities – as one of the most critical components to sustainable payment and delivery reform. This sentiment was repeated by several other panelists, including Helen Darling of the National Business Group on Health, who noted that cost shifting has become the status quo, and finding someone else to foot the bill frequently masquerades as “affordability.” Reforming our unsustainable and convoluted payment system, she stated, will require transparency, delivery reform and an eye to accountability.

Scott Armstrong, president and CEO of Group Health Cooperative and ACHP Board Chairman, underscored this theme, noting that payment policy is essential, but far from sufficient. Contrasting his roles as the leader of a community health plan and as a member of the Medicare Payment Advisory Commission (MedPAC), Armstrong pressed for greater alignment between payment policy and what happens on the ground, in communities, where care is delivered. There must be alignment among all sectors around a common goal: the improved health of the patient population. No single stakeholder has all of the answers. Amplifying this point, patient and family advocate Debra Ness, president of the National Partnership for Women and Families, observed that patients and their families are, after all, the ones for whom this system is designed. To improve the health of populations, she observed, patients and their families must be engaged as equal stakeholders along with providers, health plans, employers and governments.

Armstrong pointed to several fundamental elements that define a high functioning health care system: among them, systemic alignment around the common goals of better health, better health care, and lower cost; positioning primary care as the centerpiece of the system; using technology to support the easy transfer of information that will improve care and coordination; and designing health care coverage and delivery to incentivize patients and the system to do the right things at the right time.

Both Armstrong and Cropp emphasized that the path to a sustainable, quality health care system will be forged locally, and not inside the volatile, highly partisan world of Washington. What works in Seattle may not work in Poughkeepsie; building on key elements of the Triple Aim is the foundation of transformative design changes that are emerging in cities as different as Spokane, WA and Buffalo, NY. Finding common ground and points of collaboration is not simple, but it is possible in communities, even as it seems so elusive nationally.

Bill Kramer of the Pacific Business Group on Health urged accelerated implementation of what is already working in some areas to reduce costs and improve care, such as private-sector innovations and strategies. By building, strengthening and expanding on payment redesign and aligned incentives, so-called “fringe” methods will become the “new normal,” providing a foundation for market-based reform.

Dr. Cropp cited HEALTHeLINK, a health care “information highway” in Western New York that allows for the quick and reliable sharing of electronic health data among other unconnected medical professionals. Propelled by the “agency” of leaders who see themselves as accountable, HEALTHeLINK was developed as a community-owned asset that puts the patient at the center of design – protecting their privacy, but also assuring that information can travel across multiple providers and payers to support better care and streamlined coordination for patients and their families. Although providers and payers are often at odds, in Western New York they are partnering to achieve the shared goals of better patient health and more effective and efficient care.

The organizers of this forum are to be commended. Health Affairs provided an open arena, incorporating players from across the full spectrum of the health care marketplace and from divergent political perspectives into a dialogue intended to engage and educate. The uncertainty of what health care reform will look like going forward loomed over almost every discussion, whether or not it was directly addressed. Notably, the forum offered a chance to share experiences: what works, what doesn’t, what might. Most of those examples came from communities – communities where accountability and collaboration are the hammers and nails of systemic change. Disagreement remains on what health care reform should look like, but there was no quarrel on the need to improve health, improve care and lower cost.

-Patricia Smith
President and CEO, ACHP

A recording of the webinar is available at the Health Affairs website, located here.

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