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Saving money and improving health care quality

Adam Searing

With the health reform debate in full force, it’s time to take a close look at what these bills will do – not only to expand coverage and contain costs, but also to improve the quality of our health care.

To begin with, reforms in both the House and Senate bills now under consideration would help contain our nation’s health care costs in a fiscally responsible way. Key to this is the effort in Congress to expand coverage and contain costs simultaneously. Reforming one without the other is like squeezing a balloon – compress one side and the other side pops up bigger than ever.

Why? Controlling costs without expanding coverage would put an intolerable burden on hospitals and safety-net providers and, ultimately, our communities and millions of families. It would be unwise and politically unsustainable. We would be asking our providers to continue to see millions of uninsured people while lowering their costs overall as well. Conversely, coverage expansion without cost-growth containment would be fiscally irresponsible and economically unsustainable. The best strategy is to pursue both goals at the same time.

Both the Senate and House bills contain costs and expand coverage, and the way they do this is just as important. Each cost-control measure and expansion measure also looks to improve the quality of care people receive. How is it possible to move towards accomplishing all three of these critical goals at the same time?

First, the Senate reform bill receiving the most discussion right now is innovative in ways that are vital to preserving and protecting programs like Medicare for the long term and containing costs and improving efficiencies overall. For example, it would allow us to develop quality assessments in order to link payment to better-quality care. This means we can start paying for health care based on value and better health outcomes rather than paying based on the number of services or tests performed. This is good news for anyone who has a loved one struggling with illness or health problems.

The millions of people who navigate the health system every day know that their loved one needs the right test or treatment at the right time – not an abundance of repeat or erroneous services that don’t give them answers or make them better. This isn’t primarily about saving money. It’s about making health care more efficient and effective for patients. We need to apply to health care the innovative spirit Americans are familiar with in products like the iPhone. Two years ago, the iPhone cost $600 and did half of what it does now more efficiently and effectively as a $200 product.

Second, both bills introduce much-needed new models of delivering health care as we expand. Many of these new programs are specifically designed to improve care coordination and prevent unnecessary hospital readmissions. For example, North Carolina’s successful Community Care program is looked to as a national model. Community Care connects patients with primary-care physicians to create “medical homes” for families and builds an environment where groups of doctors – not insurance companies – work together to identify how to better care for their patients.

Because congressional passage of health reform is only the start of the work we need to fix our broken health care system, reform will allow us to test new models over time so we can find out what works the best and continuously build on our success.

There are no silver bullets or easy answers. Realistically, expanding coverage will increase costs in the short-term. But over the long-term, the health care delivery, quality and payment reforms contained in the reform bills offer an essential framework for lowering the trajectory of health care costs. The status quo is no longer an option and the cost of doing nothing is too high – for families, workers, health care providers, businesses and for the nation’s long-term fiscal health. Balancing the need for change and making sure we do change right is the key to sustainable reform.

Adam Searing is director of the North Carolina Health Access Coalition.

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