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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
THE LEARNING HEALTH SYSTEM SERIES
THE HEALTHCARE IMPERATIVE
Lowering Costs and Improving Outcomes
Workshop Series Summary
Pierre L. Yong, Robert S. Saunders, and LeighAnne Olsen, Editors
ROUNDTABLE ON VALUE & SCIENCE-DRIVEN HEALTH CARE
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington D.C.
www.nap.edu
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W.
Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This project was supported by the Peter G. Peterson Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
International Standard Book Number-13: 978-0-309-14433-9
International Standard Book Number-10: 0-309-14433-7
Additional copies of this report are available from the
National Academies Press,
500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.
Copyright 2010 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2010. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington, DC: The National Academies Press.
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.
www.national-academies.org
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
ROUNDTABLE ON VALUE & SCIENCE-DRIVEN HEALTH CARE1
Denis A. Cortese (Chair), Emeritus President and Chief Executive Officer,
Mayo Clinic;
Foundation Professor,
ASU
Donald Berwick, Administrator,
Centers for Medicare & Medicaid Services (ex officio)
David Blumenthal, National Coordinator,
Office of the National Coordinator for Health IT (ex officio)
Bruce G. Bodaken, Chairman, President, and Chief Executive Officer,
Blue Shield of California
David R. Brennan, Chief Executive Officer,
AstraZeneca PLC
Paul Chew, Chief Science Officer and CMO,
sanofi-aventis U.S., Inc.
Carolyn M. Clancy, Director,
Agency for Healthcare Research and Quality (ex officio)
Michael J. Critelli, Former Executive Chairman,
Pitney Bowes, Inc.
Helen Darling, President,
National Business Group on Health
Thomas R. Frieden, Director,
Centers for Disease Control and Prevention (designee: Chesley Richards) (ex officio)
Gary L. Gottlieb, President and CEO,
Partners HealthCare System
James A. Guest, President,
Consumers Union
George C. Halvorson, Chairman and Chief Executive Officer,
Kaiser Permanente
Margaret A. Hamburg, Commissioner,
Food and Drug Administration (ex officio)
Carmen Hooker Odom, President,
Milbank Memorial Fund
Ardis Hoven, Professor of Medicine,
University of Kentucky; Chair-elect, American Medical Association
Brent James, Chief Quality Officer and Executive Director,
Institute for Health Care Delivery Research, Intermountain Healthcare
Michael M. E. Johns, Chancellor,
Emory University
Craig Jones, Director,
Vermont Blueprint for Health
Cato T. Laurencin, Vice President for Health Affairs,
Dean of the School of Medicine, University of Connecticut
Stephen P. MacMillan, President and Chief Executive Officer,
Stryker
Mark B. McClellan, Director,
Engelberg Center for Healthcare Reform, The Brookings Institution
Sheri S. McCoy, Worldwide Chairman,
Johnson & Johnson Pharmaceuticals Group
Elizabeth G. Nabel, President,
Brigham and Women’s Hospital
1
Formerly the Roundtable on Evidence-Based Medicine. IOM forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
Mary D. Naylor, Professor and Director of Center for Transitions in Health,
University of Pennsylvania
Peter Neupert, Corporate Vice President,
Health Solutions Group, Microsoft Corporation
Nancy H. Nielsen, Past President,
American Medical Association
William D. Novelli, Former CEO,
AARP;
Professor,
Georgetown University
Jonathan B. Perlin, Chief Medical Officer and President,
Clinical Services, HCA, Inc.
Robert A. Petzel, Under Secretary,
Veterans Health Administration (ex officio)
Richard Platt, Professor and Chair,
Harvard Medical School and Harvard Pilgrim Health Care
John C. Rother, Group Executive Officer,
AARP
John W. Rowe, Professor,
Mailman School of Public Health, Columbia University
Susan Shurin, Acting Director,
National Heart, Lung, and Blood Institute (ex officio)
Mark D. Smith, President and CEO,
California HealthCare Foundation
George P. Taylor, Assistant Secretary for Health Affairs (Acting),
Department of Defense (designee: Michael Dinneen) (ex officio)
Reed D. Tuckson, Executive VP and Chief of Medical Affairs,
UnitedHealth Group
Frances M. Visco, President,
National Breast Cancer Coalition
Workshop Planning Committee
Arnold Milstein (Chair),
Pacific Business Group on Health
Kathleen Buto,
Johnson & Johnson
Robert S. Galvin,
Global Healthcare/General Electric
Paul B. Ginsburg,
Center for Studying Health System Change
Eric Jensen,
McKinsey Global Institute
James Mathews,
Medicare Payment Advisory Commission
Nancy H. Nielsen,
American Medical Association
Steven D. Pearson,
Institute for Clinical and Economic Review
Gail Shearer,
Consumers Union
Reed V. Tuckson,
UnitedHealth Group
Roundtable Staff
Christie Bell, Financial Associate
Patrick Burke, Financial Associate (through December 2009)
Jane Fredell, Program Assistant (through September 2009)
China Dickerson, Program Assistant (through November 2009)
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
Chanda Ijames, Program Assistant (through December 2009)
J. Michael McGinnis, Senior Scholar and Executive Director
Claudia Grossmann, Program Officer
LeighAnne Olsen, Program Officer (through June 2010)
Brian Powers, Program Assistant
Robert Saunders, Program Officer
Pierre L. Yong, Program Officer (through May 2010)
Kate Vasconi, Senior Program Assistant
Catherine Zweig, Senior Program Assistant (through June 2010)
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Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report:
Helen Darling, National Business Group on Health
Robert S. Mecklenberg, Virginia Mason Medical Center
Sheila Smith, Office of the Actuary
Sean Tunis, Center for Medical Technology Policy
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Floyd Bloom. Appointed by the National Research Council and the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the editors and the institution.
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Institute of Medicine
Roundtable on Value & Science-Driven Health Care1
Charter and Vision Statement
The Institute of Medicine’s Roundtable on Value & Science-Driven Health Care has been convened to help transform the way evidence on clinical effectiveness is generated and used to improve health and health care. Participants have set a goal that, by the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence. Roundtable members will work with their colleagues to identify the issues not being adequately addressed, the nature of the barriers and possible solutions, and the priorities for action, and will marshal the resources of the sectors represented on the Roundtable to work for sustained public-private cooperation for change.
******************************************
The Institute of Medicine’s Roundtable on Value & Science-Driven Health Care has been convened to help transform the way evidence on clinical effectiveness is generated and used to improve health and health care. We seek the development of a learning health system that is designed to generate and apply the best evidence for the collaborative healthcare choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care, and to ensure innovation, quality, safety, and value in health care.
Vision: Our vision is for a healthcare system that draws on the best evidence to provide the care most appropriate to each patient, emphasizes prevention and health promotion, delivers the most value, adds to learning throughout the delivery of care, and leads to improvements in the nation’s health.
Goal: By the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence. We feel that this presents a tangible focus for progress toward our vision, that Americans ought to expect at least this level of performance, that it should be feasible with existing resources and emerging tools, and that measures can be developed to track and stimulate progress.
Context: As unprecedented developments in the diagnosis, treatment, and long-term management of disease bring Americans closer than ever to the promise of personalized health care, we are faced with similarly unprecedented challenges to identify and deliver the care most appropriate for individual needs and conditions. Care that is important is often not delivered. Care that is delivered is often not important. In part, this is due to our failure to apply the evidence we have about the medical care that is most effective—a failure related to shortfalls in provider knowledge and accountability, inadequate care coordination and support, lack of insurance, poorly aligned payment incen
1
Formerly the Roundtable on Evidence-Based Medicine.
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
This summary highlights the presentations and discussions from these workshops, delving into the major causes of excess spending, waste, and inefficiency in health care; considering the strategies that might reduce per capita health spending in the United States while improving health outcomes and preserving innovation; and exploring the policy options that would facilitate those strategies. The ideas and observations throughout this volume are offered in the belief that health reform, now and in the future, will benefit from identifying actionable options to lower healthcare costs in ways that maximize value.
I would like to extend my personal thanks especially to the Peter G. Peterson Foundation and its President, David Walker, to the Planning Committee assembled for the series, to the Roundtable membership for their continued leadership and commitment to advancing health care in this nation, and to the Roundtable staff for their contributions in coordinating and supporting the meeting series and ongoing Roundtable activities.
Harvey V. Fineberg, M.D., Ph.D.
President, Institute of Medicine
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
Preface
Stimulated by the challenges facing our nation as healthcare expenditures continue to soar and threaten our fiscal future, the four-part workshop series The Healthcare Imperative: Lowering Costs and Improving Outcomes, supported by the Peter G. Peterson Foundation, explored in detail the sources and implications of waste and excess cost in health care, as well as the strategies and policies necessary to address the issues. This volume summarizes the workshops, which were convened in May, July, September, and December of 2009 by the Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care (formerly the Roundtable on Evidence-Based Medicine), as part of its Learning Health System workshop series. These meetings offered a forum for the broad spectrum of stakeholders in health to discuss the range of issues pertinent to reducing health spending without compromising health status, quality of care, or valued innovation. The discussion summary and its related presentations reflect the contributions of experts from multiple sectors involved in leadership, policy, practice, and innovation on behalf of better value in health care.
Guided by its membership, the vision of the IOM Roundtable on Value & Science-Driven Health Care is to catalyze the development of a learning health system—a system in which the processes and systems utilized by the healthcare system enable both the natural delivery of best care practices and the real-time generation and application of new evidence. With the support of senior leadership from the country’s key healthcare sectors, the Roundtable has furthered its vision through collaborative initiatives, including public workshops and published proceedings. This workshop series emerged from prior work of the Roundtable on value in health care,
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
as well as the ongoing dialogue on healthcare reform, and provided a forum for stakeholders to discuss their perspectives and to identify ideas and areas for further consideration.
The contributions of the workshop discussions to better understanding have been conceptual, quantitative, and qualitative. Conceptually, the approach fashioned by the Planning Committee grouped the sources of excess costs in health care into six domains: unnecessary services (volume), services delivered inefficiently, prices that are too high, excessive administrative costs, missed prevention opportunities, and fraud. Except for the last, the sessions organized by the Committee for the first workshop reviewed these domains in detail, and, while much work remains, the workshop presentations have offered a substantially enhanced understanding of the nature and size of the problems in each of those domains. Two things are clear: (1) each is an important contributor to excessive healthcare costs, and (2) the amount of excessive costs incurred from each is tremendous.
In discussions about potential cost control strategies and policy options, key levers for change were identified and considered in the second and third workshops, as vehicles for initiatives of particular policy relevance, including payment transformation, governance streamlining, transparency, knowledge development, care system redesign, and community health capacity. The nature, barriers, and potential impact of the various measures were extensively explored. At the request of the Planning Committee, a fourth workshop was scheduled to focus solely on the Series’ motivating proposition: reducing healthcare costs by 10 percent within 10 years, without compromising health outcomes or valued innovation.
Throughout the progression of the meetings, a number of opportunities and challenges were also identified around which the engagement of stakeholders such as those represented on the Roundtable, might be especially important and facilitative. These issues will be explored through future workshops, commissioned papers, collaborative activities, and public communication efforts.
We are especially indebted to the members of the Planning Committee, which crafted this unusually productive and path-breaking discussion series. The members of this stellar group were: Arnold Milstein (Pacific Business Group on Health, Committee Chair), Kathleen Buto (Johnson & Johnson), Robert S. Galvin (Global Healthcare/General Electric), Paul B. Ginsburg (Center for Studying Health System Change), Eric Jensen (McKinsey Global Institute), James Mathews (Medicare Payment Advisory Commission), Nancy H. Nielsen (American Medical Association), Steven D. Pearson (Institute for Clinical and Economic Review), Gail Shearer (Consumers Union), and Reed V. Tuckson (UnitedHealth Group).
Multiple other individuals and organizations donated their valuable time toward the development of this publication. We naturally also ac-
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
knowledge and offer strong appreciation for the contributors to this volume, for the care and thought that went into their analyses and presentations, for the ideas and observations they shared at the workshops, and for their contributions to this summary publication. In this respect, we should underscore that this volume contains a collection of individually authored papers and intends to convey only the views and beliefs of those participating in the workshops, not the express opinions of the Roundtable on Value & Science-Driven Health Care, its members, its sponsors, or the Institute of Medicine.
A number of Roundtable staff played instrumental roles in coordinating the workshops and translating the workshop proceedings into this summary, including Pierre L. Yong (the staff officer with primary responsibility), Catherine Zweig, LeighAnne Olsen, Kate Vasconi, Jane Fredell, China Dickerson, Chanda Ijames, Patrick Burke, Christie Bell, and Ruth Strommen. Franklin A. Cruz also contributed substantially to publication development. We would also like to thank Vilija Teel, Jordan Wyndelts, Michele de la Menardiere, and Jackie Turner for helping to coordinate the various aspects of review, production, and publication.
Clearly, successfully addressing the challenges of lowering healthcare expenditures while preserving outcomes and innovation will require significant effort and collaboration. We believe the dialogue emerging from The Healthcare Imperative begins to define the opportunities and options for successfully tackling this challenge, and look forward to continued learning from its insights.
Denis A. Cortese
Chair, Roundtable on Value & Science-Driven Health Care
J. Michael McGinnis
Executive Director, Roundtable on Value & Science-Driven Health Care
Arnold Milstein
Planning Committee Chair
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Contents
Synopsis and Overview
1
SECTION I:
EXCESSIVE HEALTHCARE COSTS
1
THE HEALTHCARE IMPERATIVE
69
Promoting Efficiency and Reducing Disparities in Health Care,
Peter R. Orszag
72
Why Americans Spend More for Health Care,
Eric Jensen and Lenny Mendonca
76
2
UNNECESSARY SERVICES
85
Saving Money (and Lives),
Amitabh Chandra, Jonathan S. Skinner, and Douglas O. Staiger
86
Regional Insights and U.S. Health Care Savings,
Elliott S. Fisher and Kristen K. Bronner
95
Opportunities to Reduce Unwarranted Care Differences,David Wennberg
101
3
INEFFICIENTLY DELIVERED SERVICES
109
Costs of Errors and Inefficiency in Hospitals,
Ashish Jha
111
Costs from Inefficient Use of Caregivers,
Robert S. Mecklenburg and Gary S. Kaplan
116
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Costs from Physician Office Inefficiencies,
William F. Jessee
125
Low-Cost Hospitals with High-Quality Scores,
Arnold Milstein
129
Costs of Uncoordinated Care,
Mary Kay Owens
131
4
EXCESS ADMINISTRATIVE COSTS
141
Excess Billing and Insurance-Related Administrative Costs,
James G. Kahn
142
What Does It Cost Physician Practices to Interact with Payers?,
Lawrence P. Casalino, Sean Nicholson, David N. Gans, Terry Hammons, Dante Morra, and Wendy Levinson
151
Cost Savings from Simplifying the Billing Process,
James L. Heffernan, Bonnie B. Blanchfield, Brad Osgood, Rosemary Sheehan, and Gregg S. Meyer
159
Excess Health Insurance Administrative Expenses,
Andrew L. Naugle
166
5
PRICES THAT ARE TOO HIGH
175
Price Implications of Hospital Consolidation,
Cory S. Capps
177
Prescription Drug Prices,
Jack Hoadley
187
Durable Medical Equipment Prices,
Thomas J. Hoerger
197
Market Pricing and the Medicare Program,
Mark E. Wynn
202
Medical Device Prices,
Jeffrey C. Lerner
209
6
MISSED PREVENTION OPPORTUNITIES
219
The Price Paid for Not Preventing Diseases,
Steven H. Woolf
220
Cost Savings from Primary and Secondary Prevention,
Thomas J. Flottemesch, Michael V. Maciosek, Nichol M. Edwards, Leif I. Solberg, and Ashley B. Coffield
225
Tertiary Prevention and Treatment Costs,
Michael P. Pignone
232
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SECTION II:
STRATEGIES THAT WORK
7
STRATEGIES THAT WORK
241
Strategies That Work and How to Get There,
Glenn Steele, Jr.
245
International Success at Cost Containment,
Gerard F. Anderson
251
8
KNOWLEDGE ENHANCEMENT
257
Successes with Cost and Quality,
Lucy A. Savitz
259
The Value of Electronic Health Records with Decision Support,
Rainu Kaushal and Lisa M. Kern
265
Comparative Effectiveness Research,
Carolyn M. Clancy
270
Enhancing Clinical Data as a Knowledge Utility,
Peter K. Smith
273
9
CARE CULTURE AND SYSTEM REDESIGN
281
Community-Engaged Models of Team Care,
Michelle J. Lyn, Mina Silberberg, and J. Lloyd Michener
283
Using Production System Methods in Medical Practice:
Kim R. Pittenger
287
Managing Variability in Healthcare Delivery,
Eugene Litvak, Sandeep Green Vaswani, Michael C. Long, and Brad Prenney
294
Cost Savings from Managing High-Risk Patients,
Timothy G. Ferris, Eric Weil, Gregg S. Meyer, Mary Neagle, James L. Heffernan, and David F. Torchiana
301
Health Information Exchange and Care Efficiency,
Ashish Jha
310
Antitrust Policy in Health Care,
Roger Feldman
314
Reducing Service Capacity: Evidence and Policy Options,
Frank A. Sloan
319
Malpractice Reform and Healthcare Costs,
Randall R. Bovbjerg
324
10
TRANSPARENCY OF COST AND PERFORMANCE
335
Transparency in the Cost of Care,
John Santa
337
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Transparency in Comparative Value of Treatment Options,
G. Scott Gazelle
340
Provider Price and Quality Transparency,
Paul B. Ginsburg
344
Transparency to Improve the Value of Hospital Care,
Peter K. Lindenauer
347
Health Plan Transparency,
Margaret E. O’Kane
352
11
PAYMENT AND PAYER-BASED STRATEGIES
359
Value-Based Payments, Outcomes, and Costs,
Harold D. Miller
361
Bundled and Fee-for-Episode Payments: An Example,
Francois de Brantes, Amita Rastogi, Alice Gosfield, Doug Emery, and Edison Machado
370
Effective Health Insurance Exchanges: An Example,
David R. Riemer
376
Value-Based Insurance Designs and Healthcare Spending,
Niteesh K. Choudhry
380
Tiered-Provider Networks and Value,
Lisa Carrara
386
Simplifying Administrative Complexity,
Robin J. Thomashauer
390
Technology and Simplifying Healthcare Administration,
David S. Wichmann
397
12
COMMUNITY-BASED AND TRANSITIONAL CARE
407
Community Health Teams: Outcomes and Costs,
Kenneth E. Thorpe and Lydia L. Ogden
408
Palliative Care, Quality and Costs,
Diane E. Meier, Jessica Dietrich, R. Sean Morrison, and Lynn Spragens
415
Community Prevention and Healthcare Costs,
Jeffrey Levi
420
13
ENTREPRENEURIAL STRATEGIES
433
Decentralizing Healthcare Delivery,
Jason Hwang
435
Retail Clinics and Healthcare Costs,
N. Marcus Thygeson
438
Care Coordination and Home Telehealth (CCHT),
Adam Darkins
443
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
SECTION III:
THE POLICY AGENDA
14
THE POLICY AGENDA
455
Getting to High-Performance,
Karen Davis
456
CBO Scoring: Methods and Implications,
Joseph R. Antos
465
15
PAYMENTS FOR VALUE OVER VOLUME
473
Bundled Payments: A Private Payer Perspective,
John M. Bertko
474
Medicare and Bundled Payments,
Armen H. Thoumaian, Linda M. Magno, and Cynthia K. Mason
478
Bundled Payment: Physician Engagement Issues,
George J. Isham
482
Patient Perspective and Payment Reform,
Nancy Davenport-Ennis
489
16
MEDICALLY COMPLEX PATIENTS
493
Payment Policies and Medically Complex Patients,
Arnold Milstein
495
Palliative Care, Access, Quality, and Costs,
R. Sean Morrison, Diane E. Meier, and Melissa Carlson
498
Payment and Better Care of Complex Patients,
Ronald A. Paulus, Jonathan Darer, and Walter F. Stewart
504
Care of Patients with Multiple Chronic Conditions,
Anand K. Parekh
509
17
DELIVERY SYSTEM INTEGRATION
517
Profile of System Fragmentation,
John Toussaint
519
Payments to Promote Delivery System Integration,
Mark E. Miller
520
Payment Reform to Promote Integration and Value,
Harold S. Luft
525
Health Information Technology to Promote Integration,
Andrew M. Wiesenthal
529
18
DELIVERY SYSTEM EFFICIENCY
535
Better Use of Healthcare Professionals,
Mary D. Naylor
536
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The Healthcare Imperative: Lowering Costs and Improving Outcomes - Workshop Series Summary
Transparency and Informed Choice,
Steven J. Spear
542
19
ADMINISTRATIVE SIMPLIFICATION
547
Administrative Simplification and Payer Harmonization,
Lewis G. Sandy
548
Payer Harmonization on the Provider Perspective,
Linda L. Kloss
552
Policies Targeting Payer Harmonization,
Harry Reynolds
556
20
CONSUMER-DIRECTED POLICIES
569
Consumer Views of Higher-Value Care,
Jennifer Sweeney
570
Insurers, Consumers, and Higher-Value Care,
Dick Salmon and Jeffrey Kang
574
Policies Shaping Consumer Preferences on Value,
Dolores L. Mitchell
577
SECTION IV:
GETTING TO 10 PERCENT
21
TAKING STOCK: NUMBERS AND POLICIES
585
A Look at the Numbers,
J. Michael McGinnis
585
22
GETTING TO 10 PERCENT: OPPORTUNITIES AND REQUIREMENTS
599
23
COMMON THEMES AND NEXT STEPS
619
APPENDIXES*
A
Workshop Discussion Background Paper
635
B
Workshop Agendas
755
C
Planning Committee Biographies
773
D
Speaker Biographies
779
*
Appendixes A-D are not printed in this book. They are available online at http://www.nap.edu/catalog.php?record_id=12750.
