Brian Klepper
What Will It Take To Re-establish Stability and Sustainability to American Health Care? Will It Be Driven Through Policy or the Marketplace?
 
 
 
Revamp Eligibility Criteria Problem As former Oregon Governor John Kitzhaber MD has persuasively argued, public programs like Medicare and Medicaid define eligibility categorically (e.g., age, gender, parental status) instead of in terms of financial need, creating inequities and squandering precious public resources. Action Establish a commission to review and recommend reforms to public health care eligibility criteria so they promote health and equitably reduce the nation's burden of acute and chronic illness. Promote Health Status Monitoring Problem Currently patient care claims are generally submitted without information about health status. This makes it difficult to track individual patient progress, or to identify larger population health problems. Action Require submission of health status (CMS’ G codes) with each claim as a condition for payment: Body Mass Index, Blood Pressure, Smoking Status, Fitness Score – Good, Fair, Poor Cholesterol, HbA1c for patients at risk of diabetes – Good, Fair, Poor. Revamp and “Balance” Reimbursements Problem Current public sector reimbursement methodologies, largely followed by private sector health plans, create incentives that distort the health care market, disproportionately favoring specialty care over primary care, and certain conditions (e.g., heart, cancer) over others. Action Establish a commission to review and develop recommendations for rationalizing health care reimbursement methodologies.
Principle 2: Modernize Publicly-Financed Health Care Programs
Wednesday, October 24, 2007