"The Growing Consensus for Payment Reform" by Andrew Dreyfus

As Brian Rosman of Health Care For All noted on Wednesday the call for payment reform was a constant refrain at the BCBSMA Foundation’s Summit on Tuesday. And the theme echoed far beyond the walls of the Kennedy Library.

• The Boston Globe editorialized that day that “the root of the problem afflicting medicine throughout the United States [is] a piecemeal approach to reimbursement that elevates individual procedures by specialists over care coordinated by a primary-care doctor” .

• The same day in Washington DC, RAND researcher Beth McGlynn told the Senate Finance Committee that “our methods of paying for health services are not aligned with the objectives of delivering high quality.”

While the consensus on payment reform has developed primarily because of rising costs, it’s important to note that payment reform does not seek solely to address affordability;

it is also a route to improved quality of care, and improved overall health.

A central goal of payment reform is to liberate physicians to provide the most appropriate service for each patient, regardless of reimbursement level. The most appropriate service could be surgery, ongoing monitoring of a chronic condition, or talking with a patient to devise prevention or treatment plans that work with the patient’s lifestyle. That decision should be made by the physician and the patient, not the fee schedule.

As Beth McGlynn told the Senate Finance Committee: “We pay more for interventions than we do for thinking and talking to a patient. We may effectively pay less if a doctor keeps a patient healthy.”

The problem with not reforming our payment system is personified by Dr. Annie Brewster, a physician at MGH who was so frustrated by the current state of primary care that she left the field after just three years. She wrote recently that “doctors should be rewarded for keeping patients well. Incentives should be based on quality outcomes and efficient resource use, not on patient volume… Patients and doctors need to come together to support healthcare reform aimed at revitalizing primary care.”

The good news, Dr. Brewster, is that doctors and patients are starting to come together, along with health plans, employers, government, and other healthcare stakeholders. Together, we can do more than just support payment reform, we can create it. The time to start is now.

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.