Health Reform: Delivering for Those Who Deliver Health Care

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    There is a growing national consensus that the U.S. health system needs substantial change, and strong reason to believe that this time long-term ideological and political divisions can be overcome. In today’s climate it is also apparent that health professionals can play a decisive role in assuring that a broad health reform proposal that has their needs in mind is enacted into law.

    In recent rounds of efforts to achieve substantial health care reforms, health professionals have been largely relegated to commenting on important but ultimately peripheral issues, while lawmakers, insurance and pharmaceutical companies, and patients’ groups took center stage in proposing and opposing insurance coverage expansion and restructuring of health care delivery. This time it is clear that the interests of clinicians to best serve their patients are aligned with the American public’s desire for a health care system that works, and that both of these goals can only be met through health reform that no longer accepts the unacceptable status quo. Today’s evolving consensus on health reform targets precisely the issues that have frustrated clinicians and hampered their ability to do their jobs.

    There is near universal agreement that the current system is broken and cannot be tolerated any longer. The clear first priority of reform is to provide every American with good health care coverage. While building on the current mixed public and private health system, health reform will eliminate the worst parts of private insurance markets, including exclusion of individuals from insurance based on pre-existing conditions, the lack of transparency about payment rates and reimbursement rules, and administrative waste associated with fragmented insurance markets. Under the envisioned competition between private plans and a public health insurance plan, it is likely that the performance of both private and public plans will improve. This approach would surely produce positive changes to the health system. If the evolving consensus produces a legislative package that falls short in some areas, additional steps can be taken in the inevitable subsequent rounds of health system reform improvements.

    The core elements of the emerging health reform package include insurance coverage expansion, delivery system reform and payment innovation, a focus on prevention and wellness, enhanced primary care and chronic care management, and comparative effectiveness. Each element will help ensure that providers are better able to serve their patients in the following ways:

    • Insurance coverage expansion: In a system in which all Americans have adequate health insurance coverage, health professionals will be able to provide needed care to all Americans without cutting corners.
    • Delivery system reform and payment innovation: Integrated delivery systems, in which physicians play a leadership role, can promote collaborative team-based care to better serve patients’ complex care needs, especially in the area of primary care and chronic care management. These systems also can promote adoption and enhancement of electronic health records, including patient access to a personalized health record via customized web portals. They can also mount and sustain systematic quality improvement and patient safety efforts.
    • Prevention and wellness: Health reform will enhance community-based care capacity by improving public health services and enabling health professionals to provide quality wellness and prevention care for individual patients.
    • Chronic care management: Coordinated care management will reduce confusion within the system and help health professionals manage patients’ chronic conditions.
    • Comparative effectiveness: Comparative effectiveness research will permit patients and their health professionals to make better decisions about care based on evidence.

    Providers have an essential role to play in shaping each of these reforms and helping to improve the system, and an improved system will also help health care professionals better serve their patients—as we discuss in detail in this paper. Each of these five elements is important in itself—but implemented together they can produce a health care system that will indeed become one of the best in the world.

    Read the full report (pdf)