Slow Spending, Improve Quality - The Commonwealth Fund

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Commentary on The Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey on Health Reform by Gail Wilensky, Senior Fellow at Project HOPE.

With so much attention being given to healthcare reform—which unfortunately seems to have morphed into health insurance reform—it's essential to remember the importance of reforming Medicare as well.

Medicare faces the same problems as the rest of the healthcare sector: unsustainable spending, and patient safety and quality challenges and the need for improved, clinically appropriate outcomes. The major problem that Medicare doesn't confront is the challenge of the uninsured. Medicare thus serves as a clear reminder that, important as it is to achieve coverage for all, universal coverage is far from being the only goal in healthcare reform and is, in fact, one of the easier challenges we face.

The major problem facing Medicare is the need to develop and implement strategies that will not only slow the spending growth rate, but also improve the quality and appropriateness of the care provided to seniors.
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Slowing spending growth and improving the clinical appropriateness and quality of care provided will involve a complex set of changes that include changing the incentives that currently reward the use of more and more-complex services, and also making available better information about the expected benefits of new technologies for various subgroups of the elderly population. Allowing Medicare to use information about comparative clinical effectiveness in setting its reimbursement policies is one strategy that may help it slow the impact of new technology on spending. Moving Medicare from a delivery system that is dominated by a la carte, fee-for-service physicians—working mainly in small groups of single-specialty physicians unaffiliated with hospitals—to a more integrated delivery system will be even more important, and more complex.

The need to move care delivery toward multispecialty physician groups that are better positioned to treat complex acute-care interventions as well as manage multiple chronic diseases is true for all of healthcare. It is just especially important for Medicare because of the greater use of medical services by the elderly population.
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