February 19, 2014
In a town that thrives on disagreement, there is a stunning degree of unanimity around the idea that the Center for Medicare and Medicaid Services (CMS) is moving in the wrong direction with its proposed regulations that would bring about sweeping changes to the Medicare Part D prescription drug program.
Over 230 organizations – representing patients, seniors, multiple healthcare sectors, employers and Americans with disabilities — have signed a letter that was delivered to CMS, urging the agency to withdraw the proposed rules. The letter states that the regulations “will severely impede beneficiaries’ access to affordable health plans and medications and threaten “to disrupt the positive effect the (Part D) program is having on beneficiaries’ health and the Medicare program as a whole.”
In thinking about these proposed rules, the first question that comes to mind is……why? The Medicare Part D program, as it stands, is an irrefutable success story. It has the approval of 90 percent of seniors. Average monthly premiums have remained at steady, affordable levels. And the cost to taxpayers over the past decade has been more than 40 percent below original Congressional Budget Office projections.
So why attempt to “fix” what isn’t at all broken?
These rules aren’t a case of tinkering at the margins of the Part D program. We’re talking about fundamental changes in how the system operates. The rules would place new restrictions on the Part D plan options available to seniors. There would be changes in the range of medications that could be available in certain pharmaceutical classes. And Congress’s clear intent that pharmaceutical pricing be determined by private sector negotiations – with the federal government keeping hands off – would be blatantly disregarded. Part D’s success in delivering affordability and healthcare quality would be placed at risk.
This is not to say that CMS, healthcare sectors and patients shouldn’t work together to continually improve the Medicare prescription drug program, but any changes should build upon the fundamental principles of consumer choice and competition that have made the program successful and improved the health and well-being of millions of beneficiaries. These proposed regulations don’t meet that criteria and, in fact, would undermine those core strengths.
November 21, 2013
There is more good news on the healthcare cost front. The White House Council of Economic Advisers has issued a report noting that real per capita healthcare spending has increased in this decade at an average annual rate of just 1.3 percent. This lower spending rate – which encompasses Medicare, Medicaid and private health insurance – represents the lowest healthcare price inflation rate in 50 years.
(Reasonable people will have differences on the reasons for this cost containment success. The White House, understandably, wants to give ample credit to the Affordable Care Act. Some say it’s a result of the nation’s economic stagnation. I would argue that innovations in many healthcare sectors – documented in detail here – are providing patients and consumers with higher quality at less cost.)
This continuing trend regarding healthcare costs deserves special attention as a special joint congressional committee negotiates budgetary issues. There is a desire among many lawmakers to do away with all or part of the budget sequester and replace it with targeted cuts. The data we’re seeing from the White House and other sources underscores that there is no compelling reason to target healthcare programs for arbitrary reductions, cuts that could have an adverse impact on access, quality and innovation and undo many of the successes we’re seeing in containing long-term cost escalation.
Instead, if Congress is looking for some possible pools of money to replace sequester cuts, a good idea might be hiring the Pentagon some better accountants to see what the military is getting for trillions of dollars in spending that has, according to a Reuters investigation, never been sufficiently audited. Just a thought.
October 16, 2013
Right now, I’m attending the annual Cleveland Clinic Innovation Summit, which is focused this year on obesity, diabetes and the metabolic crisis. Speakers have addressed in detail the linkage between body weight and the chronic diseases – diabetes, heart disease, cancer – that are the leading drivers of healthcare cost increases.
While these important discussions are taking place in Cleveland, an important development on this front was presented to the public on the pages of the American Journal of Medicine. A study by the Baylor School of Medicine (Baylor is a Healthcare Leadership Council member) presented clear evidence on how individuals can more effectively lose weight.
The study found that people enrolled in community-based weight loss programs offered by Weight Watchers (also a Healthcare Leadership Council member) were much more successful in shedding pounds than those who took a do-it-yourself approach. Among the findings:
• At six months, the test group assigned to the Weight Watchers program lost an average of 10.1 pounds. Those who were sent home with dietary and exercise self-help materials lost an average of 1.3 pounds.
• Those who engaged in Weight Watchers were eight times more likely to achieve at least a five percent weight loss than those doing it on their own.
• Participants who engaged with Weight Watchers through all three available avenues – in-person meetings, mobile applications and online tools – experienced the greatest weight loss.
This is a significant study, particularly given our national imperative to achieve a greater degree of population wellness. We now have compelling evidence that weight loss is more effectively achieved when individuals can utilize the expertise provided by an organization like Weight Watchers and when there is a social support mechanism to the weight loss effort.
Or, as Weight Watchers co-chief scientific officer Karen Miller-Kovach, MS, RD, put it, “Multiple access routes to engage with a proven weight loss approach make a measurable difference.”
August 22, 2013
Building on my last post about U.S. healthcare leaders making a difference – one for which they’re often not given full credit – in containing health system costs while still elevating care quality and improving patient outcomes, I want to bring attention to a speech made by Dr. Steven Corwin, the CEO of New York-Presbyterian Hospital. Dr. Corwin is a member of the Healthcare Leadership Council.
What I particularly like about Dr. Corwin’s remarks, covered in the Jamestown Post-Journal, is that he doesn’t bemoan the challenges facing hospital leaders, but rather sees progress as inevitable. As he put it, “What I want you to keep in mind today as we discuss the problems with our health care system is: They are solvable. This is a great country with great minds. We can address these problems. And, we can continue the art of progress, so that we can reduce the burden of disease in our society.”
The article about his speech includes two particular points worth highlighting. One is that New York-Presbyterian, one of the nation’s most well-respected health systems, plans to cut costs by $150 million over the next three years, but will do so without sacrificing the quality of care it provides patients. He pointed out that savings can be achieved through evidence-based medicine, team-based care and reduced variations in care.
Dr. Corwin also emphasized that, as the healthcare system moves forward, there must continue to be investment in research and innovation.
As I read the coverage of Dr. Corwin’s speech, it just drives home the point that patients will be better served and our healthcare system made more sustainable if we address our cost challenges through innovation and improvements in care that lead to a healthier population rather than arbitrary government-imposed cutbacks that can have an adverse effect on both access and quality.
August 14, 2013
It’s no longer fresh news that health cost increases are undergoing a considerable slowdown. The Centers for Medicare and Medicaid Services has presented statistics showing a historic decline in Medicare per-beneficiary spending growth and a Robert Samuelson column last week in the Washington Post noted that overall healthcare prices are undergoing the slowest rate of increase in half a century.
The lion’s share of commentary we see on these trends tend to fall into either of two camps. Some argue that we’re already seeing the beneficial effects of an Affordable Care Act that is far from fully implemented. Others say that the cost slowdown is a side effect of the nation’s lengthy period of economic doldrums and that consumers, many of whom are unemployed or underemployed, are postponing or foregoing medical spending.
Another possible contributing factor, that doesn’t receive a similar level of chatter, is that health care companies and providers have made significant strides in elevating the cost-efficiency of care and improving patient outcomes. This is happening in myriad ways including, but certainly not limited to, new steps to reduce hospital-acquired infections, advances in biopharmaceutical and technological interventions, strides in emphasizing wellness in the workplace and innovative uses of health information technology and digital communications to expand healthcare’s reach beyond the clinic and the hospital.
We have chronicled many of these episodes of progress – with documentation of dollars saved and lives affected – in our HLC Value Compendium and Wellness Compendium.
And this is an issue we’ll continue to discuss in this space because, in discussing the current healthcare cost slowdown, we shouldn’t overlook the impact of progress and innovation.