America’s Health Insurance Plans proposed a comprehensive health care program on May 29 which it estimated could reduce the nation’s health care costs by $145 billion annually by 2015 if implemented.
However, at least 2 key parts of the program, replacing the current medical liability system with a dispute resolution process and establishing a comparative effectiveness standard for treatments and drugs face strong political opposition, according to a health care analyst.
In announcing the plan, AHIP said its “strategy” team “innovative health plan cost containment tools with sensible public policy initiatives” that would make health care more affordable.
The AHIP plan involves better disease management, care coordination and prevention programs. It also calls for handling claims electronically, transitioning to a value-based payment system, and addressing how new technology can be most effectively introduced into the system.
“The AHIP proposal presents programs that are working now in these areas and maps out how the public and private sectors can work together to achieve these goals,” the trade group said.
A key part of the program would be implementation of comparable effectiveness studies that would evaluate different treatments and drugs and decide which works best.
The AHIP proposal calls for giving providers, patients and purchasers “access to a trusted source where they can find up-to-date and objective information on which health care services are most effective and provide the best value.”
But, Ira Loss, a health care analyst at Washington Analysis, cautions that implementation of such a program is “not likely to happen anytime soon.”
For one thing, “there have never been any studies done to compare various drugs that treat the same problem,” he said. Another is that the Medicare Modernization Act of 2003 calls for comparative effectiveness studies to be conducted, but the provision has never been funded.
“The drug industry adamantly opposes this,” he said. “Their argument is that ‘drugs do not work on all people the same way, and the industry does not want anyone other than the doctor and the patient deciding what treatment should be authorized’.”
AHIP officials added that the new proposal is part of an 18-month effort “to present a roadmap that offers comprehensive solutions to address the nation’s health care crisis.
“These solutions have been designed to be workable, affordable, and achievable now–through a uniquely American public-private effort,” officials of the trade group said.