HCI3 Update From the Field: A New Year Brings New Opportunities

Submitted by francois.debrantes@hci3.org on Friday, December 27, 2013 - 12:46

Newtown, CT – December 27, 2013

In a few days the calendar resets and provides us an opportunity to measure what has improved and what still needs to – certainly we can and should celebrate that fewer are uninsured. We should also take stock of the marked decrease in overall health care expenses. Hospitals and physicians are participating in new payment models at a rate that has rarely been seen before. Health plans are moving away from basic fee for service contracts, and states are initiating value-based insurance design and payments in bold new ways. The lack of transparency in price and quality is finally getting the attention it deserves and several states have initiated new laws and regulations to ensure that its residents have access to much needed information. Employers have broadened their use of market making tools such as Centers of Excellence and reference pricing, rewarding more reasonably priced providers with additional market share. All of this bodes well for the future affordability of health care by average Americans, but much remains to be done.

What this means to you – there are still tens of thousands of excedent deaths in the US compared to the best in class countries. Far too many die from health care related mistakes, injuries, and lack of access. The inefficiencies still far outnumber efficiencies by hundreds of billions of dollars. Innovative payment models cover less than 20% of all health care expenses, which means that the majority of providers continue to be encouraged to produce more than they should and at far too high a price. Two thirds of the states continue to have little, if any, public information on the price and quality of health care services. So yes, some progress has been made, and we should all be happy it has, but we must also clearly double down in this new year if we want to solidify these gains and make sure they never get rolled back.