HCI3 Update from the Field: The Last Decade

Submitted by francois.debrantes@hci3.org on Friday, September 9, 2011 - 03:00

Newtown, CT – September 9, 2011

As we approach the sad tenth anniversary of the September 11th 2001 events, we must take pause to consider the path traveled since and the path we must travel from now on – On September 11th 2001, I was in Kentucky, with one of my sons, waiting to present to hospitals in Anthem's network that participated in its quality improvement and incentives program. The talk was focused on the Leapfrog Group's efforts and the imperative for hospitals across the country to report on these few important measures in a very public way. In 2001, CMS Compare didn't exist. Nor did any of the other value-based purchasing programs that are now integrated into the fiber of Medicare payment. Add to those the stipulations of the ACA for innovative payment pilots and delivery system reform, and the recent announcements by the CMMI on payment reform, and we have traveled quite a path. However, we are reminded in two papers published in this month's Health Affairs, that the path traveled so far has failed to stem the rising price of health care. Auerbach and Kellerman show vividly how premium increases in the past decade have wiped away any income gains made by average US families. In fact, they conclude that the rising cost of premiums and out-of-pocket expenses have impoverished America. And Laugesen and Glied place the responsibility squarely on the rise in prices. While they focus on physician fees, our own work for a large self-insured employer shows that hospital prices, in particular, are responsible for a significant percentage of total premium cost increase. It's pretty clear that we must now embark aggressively on a new path.

What this means to you – The groundwork for this new path has been laid by the work done since 2001. It is paved with payment and delivery system reform, and some have already stepped onto this new path with, for the first time in more than a decade, CMS in the lead. Private sector payers must follow. Their seeming inability to control the rising prices of providers has made millions of US residents poorer than they were in 2001. And yet a decade ago, the IOM had clearly signaled that payers, public and private, had to look themselves squarely in the mirror and acknowledge their responsibility for the failure of the US health care system caused by the destructive effects of fee-for-service. CMS has finally looked into that mirror and acted. Quite a few in the private sector have as well. The rest need to follow.

For many hospitals and physicians, the path ahead is not going to be pleasant. However, we all must make sacrifices if the country is to finally rebound from the sequelae of 9/11. Certainly, the majority of US families have made tremendous sacrifices this past decade. To some extent, the past decade has been a lost decade, ensnared in unending conflicts, the near destruction of the international financial system, and the advent of the Great Recession. This next decade can be the start of our rebirth. The path is there. We're on it. Jump on as well. 


Francois de Brantes
Executive Director
Health Care Incentives Improvement Institute, Inc.
w: www.hci3.org