On February 14, 2013, Elizabeth Mitchell, NRHI’s Board Chair, and Harold Miller, NRHI’s CEO, each gave invited testimony at a hearing of the Subcommittee on Health of the House Energy and Commerce Committee of the U.S. Congress.
Key points in Mitchell’s testimony include:
- There is no ‘one size fits all’ solution. Quality and costs vary dramatically across the country and across communities, and so improvement opportunities and priorities vary by region.
- Data is essential to improvement. Data plays many critical roles in healthcare improvement including:
- Identifying priority cost and quality improvement opportunities;
- Enabling performance measurement and public reporting;
- Establishing cost and quality performance targets;
- Informing choice by consumers;
- Engaging physicians and other stakeholders in care improvement; and
- Managing population health.
- Medicare’s Qualified Entity program is an important step toward giving communities and providers the information they need to improve care and value. CMS should not only continue to enable qualified groups to share data for improvement, but should consider accelerating that work with financial resources and greater flexibility.
- Regional Collaboratives should be considered key implementation partners in care improvement. Regional Health Improvement Collaboratives are capable stewards of multipayor data and are experienced leaders using data with physicians and community stakeholders to improve care.
Points in Miller’s testimony included:
- Fundamental changes in the fee-for-service system are necessary in order to control the growth of Medicare spending and to improve the way care is delivered to Medicare beneficiaries. Congress will have limited success in controlling Medicare spending and providing truly high-quality care to Medicare beneficiaries if it merely uses quality-based pay-for-performance or shared savings programs built on top of the dysfunctional fee-for-service system. Fortunately, there are better ways of paying physicians that can enable them to make more significant improvements in patient care and achieve greater savings for Medicare.
- Accountable payment models need to be designed and implemented as quickly as possible in ways that will work for every specialty and every part of the country. To do this, Congress should establish a new, bottom-up approach to payment reform, whereby physicians, provider organizations, medical specialty societies, and regional multi-stakeholder collaboratives are invited to develop payment models that will work well for individual physician specialties in the realities of their own communities.
- Physicians need to be given access to Medicare claims data so they can determine where the opportunities for saving are, how care will need to be redesigned to achieve those savings, and how payment will need to change to support better care at a lower cost.
- Funding should be made available to medical specialty societies and multi-stakeholder Regional Health Improvement Collaboratives to provide technical assistance to physicians.