patient experience surveys, changes in benefit design, and consumer-friendly performance reporting.

With the theoretical impact of moving all care to top-tier providers in cost, efficiency, and quality ranging from 0.5 to 5.0 percent of total medical cost, Dick Salmon of CIGNA Healthcare suggests that achieving these theoretical potentials requires providing patients with credible information that is easy to obtain and integrate into the healthcare experience. Additionally, individuals must have reasonable access to preferred providers and benefit incentives. He stresses that barriers to progress include assisting the transition from the customary method of selecting a healthcare professional based on reputation to a model based, in part, on comparison of reliable information on quality and cost. Enabling and rewarding individuals to choose the existing highest-value provider of care offers an immediate impact on the quality and affordability of health care for individuals today and would stimulate all healthcare providers to improve in the future. Because the stimulus for future improvement based on consumer choice is limited by access issues and provider loyalty, he asserts that payment reform remains essential.

Building on these concepts, Dolores L. Mitchell of the Group Insurance Commission describes increasing pressures faced by purchasers to engage their employees in the business of wellness and prudent healthcare choices. By demonstrating how one public employer engages both employees and providers by analyzing provider performance and giving employees financial incentives to use the results—ranging from premium increases to high-deductible plans—she suggests that transparency without consequences is necessary but not sufficient to affect the delivery system. She states that the road to meaningful patient engagement is steep but should be engaged with particular attention to shared sacrifice in the short term and shared responsibility in the long term.


Jennifer Sweeney, M.A.

National Partnership for Women & Families

Many consumer advocates recognize that quality, cost, and coverage are inextricably linked and that all must be addressed to achieve a healthcare system that delivers quality, affordable health care for all. Currently, Americans pay too much for a healthcare system that delivers too little. To bend the cost curve and improve the quality of care, we must address the root cause: a payment system that incentivizes quantity of care over quality of care. However, a key component of any strategy to address this must include shifting the paradigm of consumers—the patients—to examining health care through that very lens of quality. Consequently, the National

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