Tuesday, April 21, 2009

Delivery System Reform Roundtable

Before approving the nomination of Kansas Gov. Kathleen Sibelius to be HHS Secretary by a 15-8 vote, the Senate Finance Committee today held a roundtable discussion on healthcare delivery reform. There are a number of health care delivery reform initiatives in OPM's 2010 call letter noted in yesterday's Post. One of them is value based benefit designed. At the roundtable, Aetna's CEO made the following point about this concept which I found helpful
Value-Based Insurance Design. Based on evidence in the medical literature that co-payments and/or coinsurance can create barriers to care, value-based insurance design eliminates or reduces co-payments or coinsurance for certain medications or types of care that are demonstrated to be crucial in preventing or managing disease. In other words, insurance is designed so that costs are not a deterrent to individuals in seeking out the right kind of care. One important example is the various types of care that are provided with first-dollar coverage, including preventive care, routine physicals, gynecological exams and medications for chronic care conditions. In addition to offering these products in the market, Aetna and the Aetna Foundation are supporting two clinical studies to evaluate the efficacy of value based
insurance design with researchers at Brigham and Women’s Hospital and the
University of Pennsylvania.
The call letter also encourages FEHB plan carriers to address childhood obesity. The Aetna CEO made the following point in his testimony:
Childhood Obesity Pilot. In 2009, Aetna launched a childhood obesity pilot in cooperation with the Alliance for a Healthier Generation (partnership between William J. Clinton Foundation and American Heart Association), Aetna’s employer clients and the medical community. The program, currently available to five large employer groups totaling 74,000 employees, includes coverage for obesity and nutritional counseling provided by physicians, access to clinically-based community resources, educational materials distributed at the worksite and educational resources for physicians. We believe the program is breaking new
ground; currently there is no evidence-based protocol for treating childhood obesity with counseling absent a co-morbid condition (e.g., diabetes). By addressing childhood obesity before it leads to serious health complications, this program takes an important, proactive step in improving health and quality of life for children in need. Our program offers a uniquely comprehensive approach by combining proactive treatment of childhood obesity with collaboration among insurers, employers, the medical community and families.
Aetna, the Blue Cross Blue Shield Association, and the American College of Physicians struck similar notes in the support of the medical home concept. This large body of testimony appears to be a valuable resource. Chairman Max Baucus stated that "We will follow up today’s roundtable on delivery system reform with another on expanding health coverage to all Americans on May 5. And then we will have our third roundtable on financing health reform on May 14." Yesterday, in a letter to the President, Sen. Baucus and Sen. Ted Kennedy "have reiterated their commitment to moving health reform legislation in the Senate this year, and announced that their committees will mark-up comprehensive health care reform legislation in early June."

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