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"Let's Talk Payment Reform" by Andrew Dreyfus

How often do a health care visionary from Cambridge and a five-term Senator from Montana reach the same conclusion on the same day?

At a conference on the health care quality movement last month, Don Berwick equated the dilemma of our current health care system to “the tragedy of the commons.” He suggested that as long as individuals work to maximize their own benefit — which is how our system impels people to operate — the public good is left unprotected, and ultimately depleted. (Thank you Elmer Freeman for such a clear summary of the full conference.)

Opening one of a series of Senate Finance Committee hearings on health care that same day in Washington D.C., Committee Chairman Max Baucus made a stunningly similar point. He noted that “John Donne wrote that ‘no man is an island entire of itself; every man is a piece of the Continent, a part of the main,’ but the way American pays for health care is driving healthcare providers to become islands unto themselves.”

In their remarks, both influential leaders pointed to similar solutions: changing the way we pay for care to end the fragmentation in the health delivery system, and reverse the incentives that promote volume of high intensity services over quality of care and population health.

If only we could reach a similar consensus here in Massachusetts.

There is some good news on health costs. Most health leaders concur, for example, that slowing the growth of health care spending will require lowering administrative costs, preventing and managing chronic illness, and reviewing the cost-effectiveness of new medical interventions. But as a community we still resist the notion that these and other solutions require a foundational change in how we reimburse physicians, hospitals and other care providers.

Fortunately, our legislative leaders anticipated the need for payment reform, and included a commission charged with looking at this very question in the cost containment legislation passed over the summer. The Payment Reform Commission is slated to convene shortly, and not a moment too soon. With a clear mandate, strong leadership from co-Chairs Secretary Leslie Kirwan and Commissioner Sarah Iselin, and an aggressive timeline by which to report their recommendations, the Commission has a great opportunity to spur action on payment reform and solve the systemic problems presented by Don Berwick and Max Baucus.

Andrew Dreyfus is Executive Vice President for Health Care Services at Blue Cross Blue Shield of Massachusetts and former President of the Blue Cross Blue Shield of Massachusetts Foundation.

This program aired on October 15, 2008. The audio for this program is not available.

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