THE COMMONWEALTH FUND COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM Keeping Both Eyes on the Prize: Expanding Coverage and Changing the Way We Pay for Care Are Essential to Make Health Reform Work for Families and Businesses Statement from The Commonwealth Fund Commission on a High Performance Health System November 20, 2009 Families and businesses have a lot at stake in the 4) investing in public reporting, evidence-based current national health reform debate. If Congress medicine, and the infrastructure necessary to fails to act, we will continue to have poor health sys- deliver the best care; and 5) developing a leadership tem performance, eroding insurance coverage, and structure that can set aims for health system perfor- ever-rising expenditures that eat into family wages mance and priorities for improvement and monitor and savings, and drive up costs for businesses. performance. In earlier reports, published over the past several We are encouraged that, to a large extent, the years, the Commonwealth Fund Commission on debate in Congress has recognized the importance a High Performance Health System has called for of these issues. a comprehensive, integrated approach to health system reform, with the recognition that multiple While most Americans, like those in other developed changes are needed to help the U.S. achieve afford- countries, would agree that covering the uninsured able access to care for all, higher quality, and slow- is an ethical imperative to assure that all receive the er growth in costs. In particular, the Commission care they need in the event of illness or injury, many has recommended five broad strategies that should also fear that the cost of extending insurance cover- underlie comprehensive reform: 1) extending com- age to all is too high, especially during a period of prehensive, affordable, and seamless insurance economic uncertainty. But extending coverage to coverage to all; 2) aligning incentives to reward all is actually the economic cornerstone of health high-quality, efficient care; 3) organizing the health care delivery reform. If done right, covering the system to achieve accountable, coordinated care; uninsured can be key to aggressive health care cost containment by making it possible to change the current incentives that encourages waste, dupli- way we pay for care and limit spending growth, cation, and fragmentation of care. These pay- without concerns of excluding the most vulnerable ment innovations include: from needed care or undermining essential hospi- tals and physicians. »» Creating a Payment Innovation Cen- ter that will facilitate rapid adoption of Investments to enhance coverage may seem very new methods of paying that will reward large, but should be taken in the context of the results while slowing cost growth. roughly $35 trillion that we will spend on health »» Paying for better, patient-centered primary care over the next decade. If the investment can care with an emphasis on coordination and improve the efficiency of the system, returns could prevention (medical homes); holding provid- more than offset federal investment. ers accountable for outcomes (accountable How does that happen? In addition to coverage care organizations that take responsibility expansions, which have garnered most of the atten- for excellent, indeed improved, outcomes); tion during the current debate, reform provisions and bundled payments that also encourage should address cost and quality. Payment and sys- coordinated care. tem reform lays the foundation for assuring that the »» Assuring the prices we pay for care are dollars we spend on health care are well spent and aligned with value and are not excessive. lead to more effective, efficient, and coordinated health care. We know from real-world experiences with- in the United States that it is possible to achieve The key elements of these strategies are: much higher quality care, with much better • An insurance exchange that provides transpar- results for patients, at lower costs when providers ent choices of health plans, including private innovate and eliminate waste. plans and any public plans or consumer coop- To stimulate such efforts nationally, we must take erative plans offered. the first steps in coverage and payment reform now. • Market rules and oversight of insurance com- This is a unique opportunity. Reforms enacted now panies to limit premium increases and reduce can provide a foundation to elaborate and refine as insurance overhead. we gain experience. If done right, upcoming health reform legislation can reverse the negative trends in • Payment innovations that reward better out- U.S. health system performance and provide a more comes and better coordinated care, and replace secure future for U.S. families and businesses. To read or download publications of the Commission on a High Performance Health System, visit The Commonwealth Fund’s Web site at www.commonwealthfund.org.