The health care reform debate has come a long way in the past 18 months. At the outset of the 2008 presidential campaign, policy distinctions remained relatively binary: Mandated coverage or no mandated coverage? Protect the tax treatment of employer-provided coverage or treat the coverage as taxable income? Now that lawmakers have begun the legislative process in earnest, the issues are no less controversial, but they have become more complex. Negotiators are now weighing a host of issues, including the role of a public plan option, the nature of mandated minimum benefits package; how subsidies for moderate income Americans would actually operate; and the question of how to finance the whole endeavor.
Most reform proposals have been driven by concerns over the lack of consistent health care coverage, to a lesser extent, the cost of health care services.
And from the beginning, these discussions have given lesser priority to the other critical component of health care reform: improving quality. A survey conducted last year by the American Benefits Council and the law firm Miller & Chevalier found that among benefits professionals, just 33 percent felt that there was insufficient discussion about improving coverage. Fully 58 percent believed there was insufficient attention paid to the issue of health costs and 74 percent felt that health care quality concerns were not receiving the attention it deserved, despite the fact that quality health care is essential to reduce costs.
A 2003 study by Dr. Elizabeth McGlynn and others, published in the New England Journal of Medicine, indicated that surveyed participants received recommended care -- preventive care, acute care and care for chronic conditions -- only 54.9 percent of the time. The American Hospital Association has estimated that ,at least 44,000, and perhaps as many as 98,000, Americans die in hospitals each year as a result of medical errors. Health care remains the only service or product for which we pay consistently high prices and receive inconsistent quality in return.
Employers are deeply concerned about cost and coverage issues, but also want to underscore the need for improving health care quality as part of the reform debate. The American Benefits Council's health care reform proposal, Condition Critical: Ten Prescriptions for Reforming Health Care Quality, Cost and Coverage, included among its prescriptions "improving the quality and efficiency of health care" and "providing clear, reliable information to make better health care decisions" through interoperable health information technology, safe harbor protections for providers utilizing evidence-based practices, and development of consensus-based quality measures.
The American Benefits Council also serves on the steering committee of Stand for Quality, a collection of more than 150 groups that issued the report "Building a Foundation for High Quality, Affordable Health Care: Linking Performance Measurement to Health Reform." This document sets forth a framework for improving the quality, efficiency and affordability of medical care:
- Set national priorities and provide coordination for quality improvement;
- Endorse and maintain nationally standardized measures;
- Develop measures to fill gaps in priority areas;
- Ensure that providers and other stakeholders have a role in developing policies on use of measures;
- Collect, analyze, and make performance information available and actionable
- Support a sustainable infrastructure for quality improvement.
Health care quality initiatives offer the potential to slash costs by reducing medical errors and the liability claims that often result from those errors, eliminating administrative waste and helping individuals to be smarter consumers of medical care.
Efforts to elevate the discussion of health care quality have been productive already. While many brokers understandably have been focused on the Economic Stimulus Act of 2009 and its compliance requirements related to subsidized COBRA coverage, a less-publicized provision in the law devoted $1 billion to comparative effectiveness research, which should help to establish priorities and research for determining the most effective treatments for particular conditions.
It remains to be seen whether health reform legislation incorporates employer recommendations for improving quality and lowering costs, or whether the debate devolves, as it so often has in the past, to a discussion focused on expanding coverage. Plan sponsors are vigorously working to ensure that all three components receive the attention they deserve. Unless that occurs, the opportunity for true reform will have been missed.
James A. Klein can be reached via e-mail at info@abcstaff.org.
