As Congress grapples with how to reduce the federal deficit, the cost of our largest social programs will be the source of much debate, particularly Medicare. A recent Congressional Budget Office report projects that by 2022 total spending for our three largest programs, Medicare, Medicaid and Social Security, will account for 55 percent of all federal spending. This level of spending is not sustainable. As a country, we must find solutions that slow the rate of spending, while maintaining access to quality health care and retirement benefits for millions of Americans.
Private Sector is Open to Change
From a health care perspective, successful reform is rooted in new ways to deliver and pay for care. The health care system of the future will not only provide access to all Americans, but also create high-quality patient outcomes, affordably priced care, and a system-wide focus on prevention and wellness. Many in the private sector are already hard at work on crafting this future.
Accountable Care Gains Traction
Hospital systems, physician groups, health insurers and employers are experimenting with new models for delivering and financing more affordable, quality care. The Accountable Care Organization model has moved to the forefront of this effort. With many pilots underway across the country, ACOs are an important learning laboratory for how to re-engineer the delivery of health care.
Effective collaboration among stakeholders will be an important success factor as ACOs continue to grow and wrestle with issues of risk management, alignment of provider incentives, and better care coordination that is supported by evidence-based medicine.
Challenging the Status Quo
On another front, several physician groups have begun to flag unnecessary tests and procedures. Earlier this year, the ABIM Foundation, established by the American Board of Internal Medicine, announced a new initiative, Choosing Wisely, which encourages physicians to talk with their patients about commonly used tests and procedures that may be unnecessary.
This step by physicians is to be applauded. It is a clear signal that physicians are reasserting their stewardship of patient care, and their accountability for the cost-effectiveness of that care. In addition, by opening a frank dialogue with patients about what is medically necessary, we can begin to chip away at the notion that we are entitled to any and all tests, regardless of what the science tells us.
Accountable Care Organizations and the Choosing Wisely initiative are two examples of how providers and other private-sector stakeholders are taking steps to effect change.
Real Change Takes Time
There is no doubt that achieving health care cost savings that contribute to lowering our nation’s deficit is a complex challenge. It will take sustained effort and cooperation by all stakeholders in both the public and private sectors if we are to fix our system, get costs under control and most importantly, create more value for Americans. I know change won’t happen overnight, but I believe we are on the right track.