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On health care’s ‘unsustainable’ model and the push to speed up innovation (originally published in Post Business blog)

On health care’s ‘unsustainable’ model and the push to speed up innovation (originally published in Post Business blog)
by Nashville Health Care Council | Mar 23, 2012

Editor’s note: This is the third in a series of posts from the Nashville Health Care Council’s Leadership Health Care Delegation to Washington. Click here for other installments from the trip.

The Tennessee delegation and key congressional staff members spoke with members of the Nashville Health Care Council’s Leadership Health Care group during a second day of sessions for LHC’s 10 Year Anniversary trip to Washington, D.C.

Tennessee Congressional Delegation members Sen. Lamar Alexander (R-TN), Rep. Marsha Blackburn (R-TN), Rep. Jim Cooper (D-TN) and Sen. Bob Corker (R-TN) discussed the top health care policy issues they think Congress and the American public should be most concerned. Notably, Rep. Cooper and Sen. Corker discussed the “unsustainable” economics of Medicare, wherein the average American receives two or three times the benefit from the government health care program over their lifetime than the amount of money they pay in.

Sen. Corker gave the example of a two-wage family paying $117,000 into Medicare over their lifetimes and receiving $357,000 out of the program.

“Until we change that formula, everything we care about will continue to diminish,” he said. “What we’re doing is not investing in research and development, not doing the things that make our country more economic and efficient because we’re not dealing with this issue.”

Sen. Alexander said there will “have to be a restructuring of our entitlement programs … to get it down to some reasonable level of growth.”

Following the discussion with the Tennessee delegation, Andrew Shin, acting director of stakeholder engagement for the Center for Medicare and Medicaid Innovation, talked about the ways in which CMS is working to develop care delivery and payment models that improve quality while reducing costs for the health care system. Specifically, he discussed the Innovation Center’s first active initiative – the Pioneer ACO Program – and the programs in process, including a national patient safety campaign, a comprehensive primary care initiative, a bundled payment for care improvement initiative, and the Health Care Innovation Challenge.

Shin said the Center is working to reduce the time it takes to spread nationwide innovative health care delivery and payment models from roughly 17 years to just three or four years.

“It’s an exciting time to do what we do in health care. The opportunities are immense, and the risks and challenges are immense,” Shin said. “But [CMS] can’t create a movement. It’s up to people on the ground, the employers and businesses, the people who know that rising health care costs is not just a business issue, it’s an economic issue.”

The day wrapped up with a panel discussion of key congressional staff, including Elizabeth Falcone, health legislative assistant for U.S. Senator Mark Warner (D-VA); Ruth McDonald, senior legislative assistant for Rep. Cooper; Anne Oswalt, health legislative assistant for Sen. Corker; and Monica Popp, health legislative assistant for the U.S. House Committee on Energy and Commerce. The panel was moderated by Sheryl Coughlin, head of research for the Deloitte Center for Health Solutions, and focused on what Congress is facing in health care policy and the budget.

McDonald pointed out that, even if Congress goes through the budget sequestration process, it will still need to look at further deficit reductions through programs such as health care.

“This is a serious problem that affects all of our bottom lines,” she said of growing health care costs. “It’s not just a Congressional problem, it’s a fifth-of-our-economy problem. There needs to be some realistic discussion about what we need to do to change the system.”

The group also talked about the importance of having individuals in Nashville and beyond reach out to their senators and representatives to share their perspectives and expertise on the health care issues before Congress.

“It’s important to have for-profit, nonprofit, boots-on-the-field advice for how things are actually working and how health care is actually working,” said Falcone, who challenged attendees to be partners and not adversaries in helping Congress make important decisions about health care policy.

Falcone, who is working on the staff level with the bipartisan ‘Gang of Eight’ focused on a creating a resolution to the national debt crisis, added: “Your opportunity is not to just say no, it’s to say ‘No, and here’s why’ or ‘Here’s how you can fix it because I think it will be a better system.’”

“Regardless of the outcome of the upcoming Supreme Court deliberations and the election, unavoidable fiscal insolvency issues must be addressed by Congress next year,” said Council President Caroline Young. “It has been gratifying to hear members of our Tennessee Congressional Delegation voicing a strong willingness to build consensus.”

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