Encouraging approaches to improving care and lowering costs in Medicare: AARP Forum

On a rainy Tuesday morning in the nation’s capital, ACHP President and CEO Patricia Smith joined a panel of health care experts and consumer advocates in the AARP Solutions Forum, “How to Improve Care and Lower Costs in Medicare: Promising Approaches.”

Promising approaches discussed by the panelists included:

  • Measuring quality
  • Providing translators to make sure these measurements are understandable to individuals
  • Reforming payment
  • Expanding the use of medical homes
  • Improving patient education and engagement
  • Coordinating care
  • Engendering seamless transitions of care
  • Instituting transparency of errors and associated quality of services
  • Proactively protecting competition in health care marketplace
  • Improving HIT

The 2 1/2 hour discussion was moderated by Susan Reinhard, AARP senior vice president and director, AARP Public Policy Institute, and G. Lawrence (Larry) Atkins, president, National Academy of Social Insurance.  Debra Whitman, AARP executive vice president, Policy, Strategy and International Affairs provided closing remarks.

AARP streamed the well-attended and lively forum as a webinar. The recorded version is available here. A selection of panel discussion is below.

Nicholas Wolter, M.D., CEO Billings Clinic: [The Institute of Medicine report recommendations provides] a road map to leverage tools to make health care safer and add value. [They include] EHR throughout—inside the clinic and remotely; seamless access to information; and understanding the importance of culture. Our primary mission is to be the best in quality, safety and value. We believe in the  integration of care model. It’s not an easy task and it requires a culture of teamwork, a culture of safety…We want to be like Mayo and Geisinger when we grow up: They care about the right things and are honest about what they are not doing well and can do better…Physician medical training positions us to think like fighter pilots—that the care is up to us. That has shifted to physicians understanding we can’t complete mission without others—team care. More like astronauts needing mission control.

Michael H. James, president and CEO, Genesys PHO: We got involved 10 years ago in primary care medical homes and came to the conclusion that every patient should have a primary care physician of his choosing and work with team of the primary care physician to improve his health. But there are not enough primary care physicians to make that so. In our system, we can and do…Next, [is becoming a] pioneer ACO medical community by integrating hospital and teams. The strength is it does break down the culture of physician as acute care provider and not relating to a patient for his whole life. Weakness is the culture of changing patients to want to change their health. We are getting patients more engaged, educating patients on their health care. For those who will stop unhealthy lifestyles, why not reduce their co-pays?

Larry Atkins, president, National Academy of Social Insurance: Step back from organizations [measuring quality] very well. How do we scale it up in communities where we don’t have these well-developed organizations?

Patricia Smith, president and CEO, ACHP: Transparency around parsimonious measures matters: Providers want to be performing in top of class. Have measures that matter to providers. Make incentives strong enough, people do follow them. Give Medicare Advantage its due. It had rough days, but now enrolling huge number of beneficiaries and lots of access and choice and driven by measures and performance standards not in marketplace.

Jennifer Eames Huff, director, Consumer-Purchaser Disclosure Project:  …According to CDC data, there is a reduction in hospital-acquired infections. But there are still 13,000 infections a year. It’s progress but we still have a ways to go—the pace is too slow. I agree totally with Tricia about the role of measurement and bringing attention and focus. I believe if we see public reporting we will see greater focus and change. We often hear about the burden, challenge, effort for systems. Lost in that conversation is burden on patients…One of the cornerstones of improving patient safety is improving transitions of care… Focus on transparency—need transparency and payment initiatives to keep pace moving and focused on direction.


Lisa McGiffert, director, Safe Patient Project, Consumers Union: We started focusing on patient safety at Consumer Union about 10 years ago. One message we keep hearing from those touched by medical harm is there is not enough urgency to preventing harm. Culture has shifted from accepting infections are inevitable, sort of hopeless. Remarkable that has changed in last 10 years.  There has been an activity uptick. But resources devoted to the issue are dwarfed by the numbers… Need high-profile reform and to educate patients… Patients have a role in reporting; we need a system that allows patients to report harm… [As for] patient- centered care: No one but patient gets to decide if care is patient-centered. Workers have to listen to patient. Just having a discussion about the issue in the absence of patients is absurd.

Leah Binder, CEO, The Leapfrog Group: …The good news is that overall health costs are slowing… Employees are paying out-of-pocket and shopping; they have skin in the game. There are pros and cons, but this is happening. The fastest form of health coverage is the high deductible. Places like GE have gone entirely high deductible. This is a major change. Employers see costs cut. But it also changes the culture. Employers are shopping. There is a movement for price transparency. Other [movement] is an acceleration to quality performance reporting. We started Hospital Safety Score, which rates safety on 2600 hospital systems, to help employers continue work to tell employees about choices. It’s also for employees: They need this information to protect themselves. The conversation about safety will drive a market for safety.

Rachel Schwartz