Expert panels on health care costs explore why costs are high and what’s coming to reduce them
by Kate Alfano, CMS Communications Coordinator
Featured in the November/December 2018 Colorado Medicine.
Two sessions during the 2018 CMS Annual Meeting featured an all-star panel of experts who explored health care costs and the role of physicians in the cost debate. The panel included Bill Lindsay, principal of Lindsay3 health care reform consulting firm; Michele Lueck, president and CEO of the Colorado Health Institute; Tamaan Osbourne-Roberts, MD, chief medical officer of the Center for Improving Value in Health Care (CIVHC); and Brian Shiozawa, MD, regional director in Region 8 of the U.S. Department of Health and Human Services.
According to a survey conducted by Kupersmit Research this summer, CMS members agree that the high cost of health care is a crisis that affects their patients daily and needs to be addressed. Many already see themselves as stewards of care, responsible for prescribing and ordering what their patients need and can afford and access, while being mindful of the overall costs to the system and the need to avoid unnecessary or repetitive visits or procedures. CMS physicians and their staff daily help patients navigate co-pays and deductibles and to find less expensive treatments, medications and imaging studies. Many CMS physicians have invested in technologies, systems of care, and education to reduce the cost of care while ensuring quality in their practice, often at significant financial cost.
Lindsay put into perspective the recent work of the Denver Metro Chamber of Commerce (DMCC) and other chambers and business coalitions to help drive efforts to contain costs via legislation, regulation and voluntary efforts, marking the first time in decades that many chambers have meaningfully engaged on health care issues. These efforts will occur whether or not there is consensus on solutions by other stakeholders.
“From the business community standpoint, we’ve been talking about this for years,” Lindsay told attendees. “This time it’s different. Employers are demanding change and employees are demanding change because at the end of the day it’s the employee who is shouldering the burden.”
Osbourne-Roberts explained CIVHC’s Total Cost of Care project, which found that Colorado’s total costs across all health care services were 17 percent higher than other states, and substantially higher with respect to outpatient services (30 percent higher). Colorado’s overall high costs were driven by both higher use of health care services and higher prices for those services when compared to other states.
“We know where we spend health care dollars; it’s less clear where we spend too many health care dollars,” Osbourne-Roberts said. “Colorado tops other states in spending primarily because of higher utilization. Higher in-state spending is driven by differences in price, although utilization is important, too. And data needs to be utilized to develop actionable strategies.”
Shiozawa presented the priorities of the U.S. Department of Health and Human Services: opioids, health insurance reform, drug pricing and value-based care. “What we won’t settle for in this country and state is bad quality,” he said. “The question is what’s the appropriate cost and utilization. Compared to other industrialized nations, we’re leading the pack and it’s not an amiable pack.”
HHS plans to encourage value-based care by maximizing health information technology, improving transparency in price and quality, pioneering bold new models in Medicare and Medicaid, and removing government burdens starting with a comprehensive review of regulations.
“As doctors, let me give you a shout out,” Shiozawa said. “Doctors are clearly the foundation of health care. Without physicians, hospitals, organizations and clinics can’t function. Businesses literally can’t survive. There has to be a balance between physician services and costs. Drug pricing is out of control.”
The agency has pledged to address high drug pricing with improved competition, better negotiation, incentives for lower list prices and lowering out-of-pocket costs.
Finally, Lueck talked about payment reform. It’s not only advancing, she said, “it is here, and we can anticipate your practices seeing it more and more over time.” She explained: Payment reform has bipartisan support at the federal level, the Medicare and CHIP Reauthorization Act (MACRA) will affect most physician reimbursement for Medicare starting in 2019, and Colorado Medicaid will begin paying primary care physicians based on their performance in 2018.
“Physicians are the most trusted component of the health care system,” Lindsay said. “You see the challenges and can effectively communicate the burdens you are facing. You understand the interconnected components of health care and can identify changes that can occur within the medical provider community.”
“The play for you is your continued involvement,” he concluded.