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Insurance Industry Proposes Changes To Nation’s Health Care Policy

Posted on: Friday, 30 May 2008, 16:05 CDT

An industry trade organization representing major U.S. health insurers has proposed several clinical and payment policy changes to reform the nation’s health care system.

The group, America’s Health Insurance Plans (AHIP), said $145 billion would be saved each year if its policy recommendations were implemented, an estimate supported by consultants at PricewaterhouseCoopers.

The United States spends $2 trillion, 16 percent of the nation’s gross domestic product, on health care each year.   According to the U.S. Centers for Medicare and Medicaid Services, that number is likely to exceed 20 percent by 2017.

Increasing costs and dwindling access to quality health care are among the top domestic issues cited by voters in national polls leading up to the November U.S. presidential election.

AHIP members are among those that helped bring down the last significant attempt at national health reform, led by then-first lady Hillary Clinton.

"We were reacting" to proposals during that time, AHIP President Karen Ignagni told Reuters.

The changes would guide patients, doctors and payers through clinical decision-making by providing access to research comparing various treatments. Such research is atypical now since manufacturers lack the financial incentive to do it.

Legislators are currently considering the establishment of an independent body to perform the research.   But the concept has some drug and medical device makers concerned that the research would be used to blindly deny treatment.

The AHIP plan also includes aligning safety and patient results with reimbursement, a central theme in many other reform proposals.   Generally speaking, such pay-for-performance models compensate doctors more when certain clinical standards are met.  The current payment system mainly pays for care on a fee-for-each-service basis, independent of outcome.

The plan also urges a focus on so-called disease management that aims to prevent and control chronic diseases, since management is typically less costly than emergency care.

"I think the important lesson is - they get a range of savings that is reasonable. It suggests there is a growing consensus that these elements are what are needed for change to happen," Len Nichols, a healthcare economist at the non-partisan research group New America Foundation, told Reuters.

Source: redOrbit staff and wire reports

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