Moving the Health Spending Conversation Forward: From the Bottom-Up to the Top-Down
The second Health Affairs and National Pharmaceutical Council event, “ Health Spending: Moving from Theory to Action,” convened more than 350 health policy experts in Washington, D.C., on Sept. 11 to explore novel solutions to rising U.S. health spending.
Attendees and speakers were asked to avoid descriptions of the problem in favor of action-oriented solutions. “My plea is that this isn’t another day of blabbering,” said NPC’s chief science officer and executive vice president Robert Dubois, MD, PhD, who opened the meeting.
The overarching questions raised by speakers centered around a question of health care philosophy: Should the country prioritize “bottom-up” strategies that identify and reduce the use of low-value services at the provider or patient level, or should more emphasis fall to “top-down” approaches that leverage a regulatory or budgetary approach to better allocate health care resources?
Among the highlights:
- Keynote speaker Reed Tuckson, MD, managing director at Tuckson Health Connections, LLC, called into question tools designed to increase accountability and control costs, which he said led to “diddly squat” when it comes to medical costs. [The health care] industry must look beyond the bottom line, he said, or “suffer the consequences politically.”
- Among the bottom-up approaches discussed was the increasingly important role of employers. “They’re the ones buying the care,” said Elizabeth Mitchell, president and CEO of Pacific Business Group on Health. According to Mitchell, employers are increasingly getting more involved in direct negotiations with providers to set incentives, reduce barriers and support greater care integration. “Employers and physicians want the same thing,” Mitchell continued. “Healthy patients are healthy employees.”
- Also discussed among bottom-up strategies was the potential use of health technology assessments (HTAs). Tufts Medical Center’s Dan Ollendorf, PhD, predicted that such tools – developed by groups like the Institute for Clinical and Economic Review – would become more prevalent in the U.S., even if applied less formally than those used in other countries. Johns Hopkins University’s Otis Brawley, MD, suggested that HTAs would be best targeted at areas of unmet need or large budget impact.
- Robin Gelburd, JD, president of FAIR Health, took a deep dive into FAIR’s health claims repository to demonstrate the need for making claims data more actionable in both system-wide reform efforts and patient-level decision-making. She likened the health care system to an interconnected root system, noting that data can increasingly be used to make smarter decisions and recognize the consequences of changes to other parts of the system.
- The case for a top-down solution was made by two speakers from North Carolina: Mandy Cohen, MD, MPH, Secretary of the North Carolina Department of Health and Human Services, and Patrick Conway, MD, president and CEO of Blue Cross and Blue Shield of North Carolina. The two executives detailed how they were working from different perspectives toward a common goal: moving 70% of all payments in state health programs to value-based payment models.
- Echoing Tuckson, Conway also emphasized the importance of working together to come up with solutions, noting that a continuation of the status quo would prompt “a legislative solution that is far more dramatic.”
- While speakers remained optimistic, realism dominated. Ceci Connolly, president and CEO of the Association of Community Health Plans, reminded attendees that every dollar of health spending was a dollar of someone in the health industry’s income, making cuts difficult, while at the same time suggesting that the rate of growth could be slowed if the country could “overcome the deep belief in the U.S. that more is better and more expensive is way better.”
Many of the experiments needed to find the path toward taking control of health spending are already underway, the panelists agreed, but there were calls throughout for more collaboration. There was broad alignment on a transition to value-based care, as well as an understanding that competition, efficiency and trade-offs would be a critical part of evolving the health system. Said Alan Weil, JD, Health Affairs editor-in-chief, in concluding the meeting: “No one is immune from participation in both the problem and the solution.”
In addition to Health Affairs and NPC, the event was supported by Going Below The Surface partners the Alliance of Community Health Plans, American Cancer Society, Blue Cross Blue Shield Association and the Council for Affordable Health Coverage.