Engelberg Center for Health Care Reform

Engelberg Center for Health Care Reform Mission The Engelberg Center is conducting a range of projects that support comprehensive health care reform. These projects and partnerships enhance the Center’s ability to implement change at all levels and bring academic and technical expertise to bear on practical solutions to state and national health care challenges. The Initiative on Value and Innovation in Health Care is the Center’s cornerstone project. The Initiative works to develop data-driven, practical health reforms that promote broad access to high-quality, affordable care with a focus on continuous health care improvement. The projects within the Initiative focus on changes in policy and practice to improve health care through innovation in biomedical science and clinical practice, reforms in health care delivery and realignment of payments and incentives to promote better evidence, better quality and better health care. Driven by staff with expertise in policy, biomedical science, and clinical practice, projects within the Initiative involve new ideas, analyses, and practical strategies for implementing them. Many of the projects are supported by broad-based collaborations with a wide range of external stakeholders. Putting this all together results in feasible approaches for driving real health care reform to achieve higher quality health care at a lower cost. (Click to Initiative page) Initiative on Value and Innovation in Health Care The Initiative on Value and Innovation in Health Care works to develop data-driven, practical solutions that promote broad access to high-quality, affordable care that keeps getting better. Simply expanding health insurance coverage to promote access, or trying to lower costs by cutting prices or limiting covered services, will not be enough to achieve health care that does much more to improve health, that is affordable, and that keeps getting better by incorporating new clinical breakthroughs and better evidence. The projects within the Initiative focus on policy and clinical practice change to improve how biomedical innovation and health care delivery really work, driven by staff with expertise in both policy and clinical practice. Putting this all together results in practical ideas for real health care reform and support to implement them to achieve better health and lower costs for each person getting care. I. Achieving High-Value Health Care Bending the cost curve in health care spending Fundamental breakthroughs in biomedical science, improvements in data systems and network capabilities, and continuing innovation in health care delivery is making health care increasingly individualized and prevention-oriented. These person-focused reforms aim to support these changes in care—not as an afterthought or as an addition to our health care financing and regulation, but as the core goal. By highlighting a clear vision for reforming Medicare, Medicaid, and the broader health care system, the Bending the Curve: A Framework for Person-Centered Health Care Reform report was produced to set the direction and tone for upcoming political action around physician payment rates, cost containment, and other evidence-driven health care reforms. The Bending the Curve project has produced three reports [links to: September 2009, July 2010 and April 2013] that contributed concrete, feasible steps to reduce health care costs and improve value simultaneously. Better Measurement of Performance in Health Care The Quality Alliance Steering Committee (QASC) promotes the implementation of meaningful quality measures, which are needed to support a high-quality, affordable, patient-centered health care system. QASC is working with key stakeholders in the public and private sectors to make standardized information about the quality and cost of health care widely available to a broad range of individuals and organizations, including patients, providers, medical facilities, health insurers, federal and state health agencies, and regional collaboratives. To support this effort, we work with a diverse group of health care reform leaders and content experts to support the implementation of better performance measures; enable providers to improve their quality of care; help consumers make informed decisions about their own health care; and facilitate the creation of public policies, payment policies, and consumer incentives that foster better provider performance. [link to QASC site: http://www.healthqualityalliance.org/ ] Reforming the Health Care Work Force Team-based care is emerging as an essential component of patient-centered medical homes, accountable care organizations, and other innovative delivery systems. A team of medical professionals is better equipped to provide high quality, comprehensive care across care settings while also ensuring that each team member is practicing to the top of their ability. Select organizations are now starting to integrate frontline healthcare workers into team-based care models. The use of frontline workers as part of the collaborative care team shows great promise as a way to bend the cost curve, improve the quality and continuity of care, and increase access to care. In collaboration with the Hitachi Foundation, the Initiative is identifying innovative workforce development programs in a variety of settings and introducing best practices to a critical group of stakeholders representing payers, delivery systems, innovators, and providers. A study team is conducting key stakeholder interviews with leaders of new models of delivery systems (e.g., accountable care organizations, patient-centered medical homes), payers, employers, and renowned national thought leaders. Qualitative and quantitative measures will be used to develop a business case for career ladder programs and workforce development. [links?] Post-Acute and Long Term Care Payment Reform The Initiative is engaged in a number of different projects to encourage reforms in the delivery of post- acute and long term care. For example, the Initiative is working to identify and evaluate alternatives to the current skilled nursing facility payment system in a collaborative approach that includes the Centers for Medicare and Medicaid Services (CMS) and relevant stakeholders; the Initiative is working to assist CMS in considering payment options for general acute and long term care hospitals that care for chronically ill populations; the Initiative is working to develop alternative payment models for Medicare Part B therapy services; and, the Initiative is engaged in a project to develop assessment tools to further the goal of introducing a core set of quality measures for long-term care. [add links] Long-Term Care Quality Alliance The Engelberg Center is supporting the Long Term Quality Alliance (LTQA), a coalition of stakeholders concerned with long-term care quality and health care reform. LTQA was formed to respond to the increasing demand for long-term services and support and the expanding field of providers who are delivering that care. LTQA is governed by a broad-based board comprised of 30 of the nation’s leading experts on long-term care related issues. In past years, LTQA has focused on innovative communities and quality measures. The group envisions a shift toward addressing issues of the dual eligible population given the fact that this group is a high-cost, vulnerable population. Additionally, LTQA would like to reposition itself in the industry and has asked the Engelberg Center for greater leadership. The Engelberg Center will sponsor a series of roundtables and opportunities for cross-stakeholder discussion of issues on long-term care. [add link to LTQA: http://www.ltqa.org/ ] Physician Payment Reform For more than a decade, the flawed Sustainable Growth Rate formula that is currently used to update the Physician Fee Schedule in Medicare has threatened access to care and caused uncertainty among physicians and others who provide services to Medicare beneficiaries. But broad bipartisan support exists for reform. Reflecting the framework developed in our “Bending the Curve” reports and related initiatives, we are supporting the development of proposals to reform physician payment. The Engelberg Center continues to be a resource to stakeholders and Congressional staff as they work through the issues involved in moving toward meaningful reform of the Medicare Physician Payment system. Mark McClellan testified before the US Senate Committee on Finance in June 2013 at a hearing entitled “Improving Health Care Quality: The Path Forward.” Kavita Patel testified before the US Senate Budget Committee in July 2013 at a hearing entitled “Containing Health Care Costs: Recent Progress and Remaining Challenges” and before the U.S. House Committee on Energy and Commerce, Subcommittee on Health at a hearing entitled “Using Innovation to Reform Medicare Physician Payment.” Dr. Richard Merkin Initiative on Payment Reform and Clinical Leadership The Dr. Richard Merkin Initiative on Payment Reform and Clinician Leadership is a mission-driven effort to generate clinician-led physician payment and delivery reform and increase the national capacity to provide leadership training to clinicians. Clinician leadership – including doctors, nurses, pharmacists, and other health professionals - is essential for innovative, high-value health care reform, and thus the Merkin Initiative underpins much of our work related to health care delivery reform. The Merkin Initiative is developing evidence-based and politically feasible payment

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