The leader of the nation’s most important health care payer joined us at our Spring Conference last week and showed us the future — a future with fundamental changes in the way we pay for and deliver health care.
Sean Cavanaugh was our keynote speaker. He is Director of the Center for Medicare at CMS and previously worked at the CMS Innovation Center, where he developed and tested new payment and service delivery models, including accountable care organizations and medical homes.
The nation is swiftly moving toward these new models as a way to improve quality and reduce costs. We spent $3.0 trillion in 2014 on health care, or 17.5 percent of our Gross Domestic Product.
Our economy cannot sustain further increases in health care spending. Yet we know as much as 30 percent of what we spend on health care is unnecessary, according to a report by the Institute of Medicine. There is a lack of coordination that leads to needless tests and treatments — as well as care that actually harms patients —at every point in health care.
Cavanaugh is leading the effort to right the ship.
But is the rest of health care ready for the revolution? Not from what we at the Quality Institute are hearing and seeing. Too few providers are paying attention to the sweeping innovations that will change how they must practice and how they will be paid.
In this emerging new world of health care, doctors will be rewarded for delivering quality care that keeps people well. That means the old model of writing a prescription and sending patients on their way will be over. Doctors will need to work with care coordinators, community health workers, perhaps diabetes educators and others across the health care continuum. They will need to follow-up with patients who miss appointments or who fail to take their medications.
Doctors must transform their clinical practices. Those that do not will be left behind. Will those providers then not accept Medicare or Medicaid?
If so, where will their patients receive care? These programs are our promises to the retirees and the poor — the safety nets in our society — so we need providers to participate.
The changes ahead transcend politics and will not go away no matter who wins the presidency or which party controls Congress. Alternative payment models have received bi-partisan support at federal and state levels. Commercial insurers and large, self-funded employers and union funds are now following Medicare’s lead.
I truly sympathize with physicians busy focusing on their patients who may not be prepared for the complexity ahead. And I want these providers to know there are resources and programs to help them understand alternative payment models.
One they should know about is the Garden Practice Transformation Network, which is being run by the New Jersey Innovation Institute, a corporation created by NJIT. Medicare is funding the institute over the next four years to engage and support thousands of clinicians in practice transformation.
The Quality Institute’s QI Collaborative also will be involved in this work. We will be running a learning network and web-based platform to provide education and training.
We will work with all of our members, those who will benefit from the resources and those who can offer their expertise. We also will be working to engage providers working in Medicaid ACOs and other providers who care for a high percentage of Medicaid beneficiaries.
Sean Cavanaugh described the new care models in a series of detailed slides. Anyone who cares about health care should start exploring the future he outlined (https://www.njhcqi.org/docs/QI-Conference-Slides_CMS-Sean-Cavanaugh.pdf) at our conference.
The time to pay attention is now.