Institute offered reflections on the estimates and the relative contributions from among the five areas, the considerations needed to assure accuracy and utility of the numbers, and the implications for the reform process. The moderator summarized the written comments of the first three, and Nichols and Reischauer addressed participants directly.

The panelists frequently converged in their comments, specifically highlighting the ideas of: dimensionalities, including the suggestions to additionally consider the nuances of identifying concrete examples of inefficiency, the varying components of pricing, the benefits of some administrative activities, and the application of such estimates to the reform process and clinical care; technical challenges, including limitations of the data and consideration of the circumstances of individual localities when implementing policy changes; and opportunities, including obesity as an area of underinvestment in prevention and the development of further refinements in the analytics that facilitate action by policy makers.

Laying the groundwork for subsequent presentations with his keynote address for the second workshop, Glenn Steele, Jr., draws on his experience leading Geisinger Health System to provide real-life examples of effective strategies to bend the cost curve. Highlighting how Geisinger has leveraged its position as both provider and payer to innovate within the current delivery system without developing new operational and financial problems, he describes their pioneering work with bundled payments for cardiac surgery, which has yielded significant improvements in the delivery of evidence-based care and decreased rehospitalizations within 30 days by 44 percent. With a focus on the high-use chronic disease population, Steele relays that their care management initiative has reduced readmission rates among the targeted population by nearly 30 percent within a year and decreased total medical costs by 4 percent—a return on investment of 250 percent. He also describes the positive externalities arising from their innovations, citing how the teachers in Danville, Pennsylvania, received an average raise of $7,000 because of Geisinger’s ability to decrease health insurance costs. Identifying Geisinger’s organization, local marketplace, financial health and planning, and the sociology of its catchment area as key elements of their local environment, he characterizes the success of their interventions in acute and chronic care as steeped in their ability to innovate, experiment, and learn “on the fly.”

In a complementary presentation, Gerard F. Anderson discusses potentially transplantable initiatives and approaches used by other nations to achieve the twin goals of expenditure control and outcomes improvement, specifically focusing on payment reforms, no-fault malpractice insurance, and care coordination. Noting that specialists in the United States earn up to 300 percent more than those in other countries, that prices for branded drugs cost up to twice as much, and that hospitals stays are up to

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