Agenda for the Next President (The Commonwealth Fund Commission on a High Performance Health System, 2007)—Davis focuses particular attention on the importance of aligning financial incentives to enhance value. In discussing fundamental payment reform that rewards physicians and other providers for achieving quality, she cites examples of successful experiments such as those at Geisinger Health System. Based on the commission’s report, significant savings opportunities could be wrought from implementing these recommendations, with a potential of $123 billion in savings over a decade from instituting bundled payment policies, $83 billion over 10 years from strengthening primary care and care coordination, and $70 billion from promoting health information technology.

Providing additional context in light of broader discussions on the analyses of the Congressional Budget Office (CBO), Joseph R. Antos of the American Enterprise Institute surveyed the analytical framework used by CBO in developing estimates of various dimensions of health expenditures, in which he emphasized that CBO considers exclusively the impact of legislation on the federal budget. He also suggested that because important considerations such as the impacts of legislative proposals on private health spending and access to care are not considered in CBO cost estimates, CBO estimates provide important but incomplete guidance to policy makers on the financial impact of potential legislation.

GETTING TO HIGH-PERFORMANCE

Karen Davis, Ph.D.

The Commonwealth Fund


Despite the fact that the United States pays more than twice as much, per capita, as other nations for health care—over $7,000 for each man, woman, and child—it still has 46 million uninsured, and another 25 million who are underinsured, meaning that they have coverage that provides inadequate protection against financial catastrophe should serious illness occur (Schoen et al., 2009). Healthcare spending is expected to double to $5.2 trillion per year by 2020 if dramatic steps are not taken soon, even as the number of uninsured continues to balloon (Schoen et al., 2009).

Everyday, Americans participate in a healthcare system that is plagued with avoidable, ineffective, and unsafe care that drive ever-higher costs (The Commonwealth Fund Commission on a High Performance Health System, 2008). The following discussion addresses the scope of the challenges and problems now confronting the country. No single strategy or silver bullet can transform the U.S. healthcare system into one of high performance. Rather, several key strategies are necessary to address the problem, some of which are currently under consideration in the health reform pending in Congress.



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