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Life Health > Health Insurance

PBGH: Support Medical Homes, Retail Clinics

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Congress could improve the quality of health care and possibly reduce the cost by supporting changes already starting to occur in the U.S. health market.

Peter Lee, a health policy analyst at the Pacific Business Group on Health, San Francisco, made that argument Tuesday during a Senate Finance Committee hearing on improving health care quality.

The hearing was part of a series of committee health reform hearings. The next hearing in the series, to focus on strategies for improving health care delivery, is scheduled to take place Sept. 16.

Lee testified during the quality hearing that one way Congress can help improve the climate for health care quality and the private health care and health finance industries is to avoid simply shifting existing costs from one group to another.

A recent study that the PBGH helped sponsor in California “found that almost 40% of the hospital costs born by private payers was not for costs of delivering services to those individuals, but rather it was paid to support the relative underpayment by Medicare and … our Medicaid program,” Lee testified, according to a written version of his remarks.

But Lee said Medicare also should look into the possibility of improving its own program, and conditions for private health plans, by making the following changes:

- Reimbursing doctors for electronic consultations with patients.

- Expanding use of electronic health records.

- Allowing physician assistants to provide more care in retail clinics.

- Updating Medicare payment policies to encourage medical care providers to work in teams and coordinate care.

- Updating payment policies to support creation of medical homes, to encourage primary care providers to spend more time talking to patients and helping patients manage their own care.

Another witness, Dr. Samuel Nussbaum, chief medical officer at WellPoint Inc., Indianapolis, said Congress should support the recommendations from the Institute of Medicine, Washington, for setting up a national clinical effectiveness assessment program; expand incentives for adopting electronic prescribing and health information technology systems; support payment systems that reward quality and superior clinical outcomes; and work with WellPoint on national drug, vaccine, and health care safety initiatives.


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