• Congress on recess . . . and so is health care reform

• Employer coalition urges Congress to consider value-based purchasing as health reform strategy

Congress on recess . . . and so is health care reform

Both the House and Senate went on their summer vacation without bringing health care reform legislation to a floor vote All three House committees with jurisdiction over the legislation have passed slightly different versions of reform legislation. The Senate Health, Education, Labor and Pensions (HELP) Committee approved its bill in July. The Senate Finance Committee, the last committee with jurisdiction, was still deliberating behind closed doors on its reform plan.

Senate Finance Committee Chairman Max Baucus, D-Mont., said he is confident a health care reform bill will reach the president's desk this year "if we all work together." Emerging with other Senate leaders from a White House luncheon meeting on August 4, Baucus said he wants a final bill to reform the health insurance industry, cut health care costs, and garner 60 votes. When asked by a reporter, he did not say whether a final package must include a specific mechanism, such as a public option or non-profit coop, to increase coverage for the uninsured.

Baucus has been working diligently for months with other key Senators in an effort to move forward a bipartisan bill that does not lose the support of Democratic members. Sen. Christopher Dodd, D-Conn., stressed that Democrats and GOP members of Congress must come back from the August recess with a "new sense of purpose" to get the bill done.

The House Energy and Commerce (E&C) Committee approved its reform bill on July 31. Comparing all three House bills (H.R. 3200) using information from the House bill as originally introduced on July 14th, information from the three House committees' web sites, and a handy tool developed by the Kaiser Family Foundation highlights the key issues regarding Medicare and Medicaid that the House will have to resolve in September before it can vote on one bill.

All three House plans call for an expansion of Medicaid to all individuals with incomes up to 133 percent of the federal poverty level. Medicaid payment rates for primary care providers would be increased to equal Medicare payment rates. The E&C Committee approved an amendment that would require states to submit a state plan amendment detailing the payment rates to be paid under the state's Medicaid program. The original bill stated that all Medicaid coverage expansions would be fully financed by the federal government; an E&C amendment calls for 100 percent federal funding through 2014 and then 90 percent federal funding starting in 2015.

While the House bill as introduced calls for enrollees in the state Children's Health Insurance Program (CHIP) to obtain their insurance through one of the new health insurance exchanges, the E&C added an amendment that this requirement not go into effect until the HHS Secretary certifies that coverage available through an exchange plan is comparable to coverage in an average CHIP plan in 2011.

E&C also approved an amendment requiring HHS to negotiate directly with pharmaceutical companies to lower drug prices under Medicare Part D and Medicare Advantage plans offering Part D plans.

H.R. 3200 calls for the establishment of a Center for Comparative Effectiveness Research; E&C added an amendment that would prohibit the use of comparative effectiveness research findings to deny or ration care or make coverage decisions in Medicare. The bill as introduced calls for pilot programs on payment incentive models for accountable care organizations, bundling post-acute care payments, and qualified medical homes. An E&C amendment would adopt these pilots as permanent parts of the Medicare program if the pilots are determined successful.

E&C also called for conducting accountable care pilot programs within Medicaid, as well as establishing a Center for Medicare and Medicaid Payment Innovation.

CCH Washington Bureau, Aug. 4, 2009.

Employer coalition urges Congress to consider value-based purchasing as health reform strategy

On August 6, 2009, the National Business Coalition on Health (NBCH), a nonprofit organization of nearly 60 employer-based health care coalitions representing over 7,000 employers, submitted letters to the White House and Congress emphasizing the importance of value-based purchasing as a critical strategy for health reform. The correspondence includes specific recommendations to reinforce the importance of establishing a health care system built on value, with a clear return for every dollar spent.

"We can all agree that the current path we are on is unsustainable," said Andrew Webber, president and CEO of NBCH. "The U.S. spends nearly twice as much per citizen on health care than any other industrialized country, and ranks in the lowest quartile on population health status. Unless we change health care to focus on delivering value --with focus on quality, health outcomes, and cost of care --America's ability to compete in a global economy is at risk."

NBCH notes in its letter that the path to health care delivery reform and cost containment is value-based purchasing. Simply stated, purchasers of health care services ( i.e., employers, governments and consumers) need to measure, publicly report and, most importantly, reward --through payment and selection --high performance and value in health care services and delivery.

Recommendations. NBCH urges the White House and Congress to continue reform legislation efforts with a focus on the following value-based purchasing pillars:

1. measuring the comparative effectiveness and performance of health services and providers;

2. making such information easily accessible and transparent to the public;

3. reforming the fee-for-service payment system;

4. empowering consumers to make better and more informed choices along the full spectrum of their health and health care journey; and

5. creating a failsafe mechanism and establishing an independent entity to ensure that serious cost containment measures are taken in response to escalating health care costs.

Source: NBCH press release, August 6, 2009.