The Dartmouth Summit: Medicare Reform Strategies to Create a Sustainable Health System

Transcription

1 The Dartmouth Summit: Medicare Reform Strategies to Create a Sustainable Health System

2 Health Care Experts Gather at Dartmouth to Consider Strategies for Medicare Reform To develop specific policy proposals to enhance the quality and reduce the cost of Medicare for bipartisan support in the 114th Congress, Dartmouth College, Dartmouth-Hitchcock Health, and the Campaign to Fix the Debt sponsored The Dartmouth Summit on Medicare Reform: Strategies to Create a Sustainable Health System. The September Summit gathered top health care policy experts from across the nation to discuss ways to reform Medicare, the federal insurance program for Americans age 65 and older. The fact that such a broad group of experts health practitioners, hospitals and health systems, medical innovators, business leaders and policymakers made the trip is a recognition of the growing consensus among health policy experts from across the political landscape: the future of Medicare remains at risk. The Summit participants discussed a variety of Medicare reforms centered around accelerating the transition away from the current fee-for-service system, to alternative payment models that reward the quality and value of care. The Summit co-sponsors, with the involvement of many of the Summit's key participants, continue to refine these policy solutions for distribution at the beginning of the 114th Congress. The formal program for the conference began with opening remarks by Dr. James N. Weinstein, Chief Executive Officer and President, Dartmouth-Hitchcock and U.S. Senator Judd Gregg, Board of Trustees, Dartmouth-Hitchcock and National Co-Chair, Campaign to Fix the Debt on The Need for Medicare Reform." Dr. Weinstein gave participants a brief overview of the challenges facing health care providers and Medicare beneficiaries under the program s current payment structure, while Sen. Gregg stressed the opportunities for bipartisan cooperation to make the program fiscally sustainable for current and future beneficiaries. For the morning keynote, the group was joined by Peter Orszag, Former OMB Director and Vice Chairman of Corporate and Investment Banking and Chairman of the Financial Strategy and Solutions Group at Citigroup, who outlined the current funding trajectory of the program. Despite some improvements in the outlook for health care spending over the last few years, Orszag highlighted that there is still work to be done to align the program so that it is providing better, more efficient care, as well as reduced costs.

3 In order to provide participants with a view of ongoing efforts to transition to new payment models across the nation, the Summit welcomed Jon Blum, Former Principal Deputy Administrator of CMS, to reflect on his recent work implementing the delivery system reforms contained in the Affordable Care Act, including Accountable Care Organizations. After his presentation, Mr. Blum joined other experts from across the country for a panel discussion focused on Lessons from the Field: Challenges of Transitioning from Fee-for-Service (FFS). Moderated by Elliott S. Fisher, the Director of the Dartmouth Institute for Health Policy & Clinical Practice, the panel also included: James E. Barr, Medical Director, Optimus Healthcare Partners ACO & Atlantic ACO, Rob Greene, EVP, Chief Population Management Officer, Dartmouth-Hitchcock, and Judith Rich, President and CEO, TMC HealthCare, with robust participation by summit attendees. During lunch, the group heard from Congressman Peter Welch (D-VT) about some of the opportunities in Congress to build bipartisan support for addressing Medicare sustainability and other challenges. After lunch, Honeywell CEO Dave Cote gave the afternoon keynote address on American Competitiveness and Providing Healthcare in a Large Company." Mr. Cote shared his insights on how rising health care costs impact American companies, not only in how they provide benefits and services to their own employees, but also how the overall issue of uncontrolled entitlement spending hurts U.S. competitiveness as a whole, especially when compared to foreign nations such as China and India. For the afternoon portion of the Summit, the participants broke into policy working groups focused on ideas to accelerate the transition away from fee for service from the perspective of The Community, Those Delivering Care, and The Individual Beneficiary. Each group was tasked with coming up with at least 5 possible policy proposals which were then presented and discussed among the full group. After discussion, the large group weighed in using an anonymous voting system to provide feedback on areas that should be considered high priority for further study. At the closing of the Summit, participants were encouraged to join in the policy development process that will stem from this initial discussion. Over the next few months, Dartmouth College, Dartmouth-Hitchcock Health, and the Campaign to Fix the Debt will work together to further identify areas of common ground for study and policy development. It is the hope of the Summit sponsors that this additional policy development will result in a menu of policy options for consideration by the 114th Congress in 2015.

4 The Case for Medicare Reform The Centers for Medicare and Medicaid Services (CMS) recently found that Medicare spending growth slowed even further last year, down from 4.8 percent in 2012 to 3.3 percent in 2013 due to payment reductions in the Affordable Care Act and the sequester, among other factors. While the slowdown is most welcome, CMS predicts Medicare per beneficiary spending growth will soon return to close to historic rates. Recently, the Congressional Budget Office (CBO) Long-Term Budget Outlook confirmed that our long-term federal debt problems remain far from solved, with the debt projected to exceed the size of the economy within 25 years. Federal spending, especially the mandatory programs in the budget such as Medicare, will continue to outpace revenue collected, running up debt and interest payments on that debt. Again, CBO found that the two factors most responsible for this increase in mandatory spending are: an aging population and excess cost growth, when health care costs are growing faster than the rest of the economy. Not only does Medicare s status quo mean an insecure fiscal future, it leaves in place fragmented care that can be difficult to navigate for the 54 million beneficiaries who rely on the program. Currently, Medicare relies primarily on a Fee-for-Service (FFS) payment model, which incentivizes providers to simply supply more services, rather than necessarily what is best for the patient s health. Care coordination that might prevent hospitalizations before they occur can actually cut into a provider s bottom line. Alternative payment models, however, have the potential to better align incentives and promote high-quality, coordinated care across multiple settings, and to pay physicians for the services patients want such as more time talking with their doctors. Providers want more flexibility to work together to care for their patients at the same time that patients want to make informed decisions about their health care.

5 In health care and on any number of issues, I ve always believed it is the obligation of the best universities to take on the great challenges facing humankind. A key strength brought by Dartmouth in particular is in forging innovation in the spaces between traditional disciplines, where diverse interests overlap. And that s precisely the goal of the Summit bringing together thought leaders and policy makers from across a spectrum of health care vocations and ideologies to explore these spaces between. At the very least, new perspectives are gained. But of course the real potential is for game-changing innovation. Philip J. Hanlon, President Dartmouth College While the recent slowdown in health care costs is encouraging, we need to do more to ensure Medicare is financially sound for future generations. We need concrete, practical options to make the delivery of health care more efficient and cost-effective that can get bipartisan support. This policy summit will bring together some of the best minds in the health care delivery system and in health policy to come up with concrete ideas to control health care costs and improve care. Erskine Bowles, co-founder of Fix the Debt Chair, National Commission on Fiscal Responsibility and Reform Reform of our Medicare system is one of the great challenges facing health care today. Dartmouth which has a long history of convening thought leadership on major issues facing our nation, and has been a leader in informing health care policy through its research is an ideal place for this Summit on reform strategies. From the work at The Dartmouth Summit, we hope to inform the creation of new policy that puts us on a path to a sustainable health system: one that not only finds new payment models, but one that will improve the lives of the people and communities we serve, for generations to come. Dr. James N. Weinstein, CEO and President, Dartmouth-Hitchcock I am pleased to be involved with the Dartmouth Summit. It featured the nation s top health care practitioners and policy experts coming together in New Hampshire to identify ways to transform the Medicare program by reducing costs, increasing efficiency, and improving the delivery of care. We need to look at health care entitlement programs for the same reason Willie Sutton looked at banks: That s where the money is. This gathering of the best and brightest thinkers in the health care sector will seek practical solutions to strengthen Medicare and is the first step toward legislative action that could garner bipartisan support in the upcoming Congress. Sen. Judd Gregg of New Hampshire, co-chair of Fix the Debt Former Chairman, U.S. Senate Committee on Health, Education, Labor, and Pensions; and the U.S. Senate Committee on the Budget To make any progress in fixing the debt, our elected leaders are going to have to work together to address one of its core drivers: health care spending. We believe the diverse group of practitioners and policy experts from all spectrums of the health industry and political realm who will be participating will shed a great deal of light on where progress can be made and that by coming up with solutions that improve delivery while reducing costs, the attendees will be doing a public service that will no doubt impact future discussions on Capitol Hill. Maya MacGuineas, head of Fix the Debt

6 About the Sponsors Dartmouth College - Founded in 1769, Dartmouth is a member of the Ivy League and consistently ranks among the world s greatest academic institutions. Dartmouth has forged a singular identity for combining its deep commitment to outstanding undergraduate liberal arts and graduate education with distinguished research and scholarship in the Arts & Sciences and its three leading professional schools the Geisel School of Medicine, Thayer School of Engineering, and the Tuck School of Business. Dartmouth-Hitchcock - Dartmouth-Hitchcock is an academic health system, serving patients across New England. A national leader in patient-centered health care, D-H is on a path to create a sustainable health system for the region and as a model for the nation. Founded in 1893, the system includes New Hampshire s only Level 1 trauma center and its only air ambulance service, as well as the Norris Cotton Cancer Center, one of only 41 National Cancer Institute-designated Comprehensive Cancer Centers in the nation, and the Children s Hospital at Dartmouth- Hitchcock, the state s only Children s Hospital Association-approved, comprehensive, full-service children s hospital. As an academic health system, Dartmouth-Hitchcock provides access to nearly 1,500 primary care doctors and specialists in almost every area of medicine, as well as world-class research with the Audrey and Theodor Geisel School of Medicine at Dartmouth. Fix the Debt - The Campaign to Fix the Debt is a nonpartisan movement to put America on a better fiscal and economic path. We have come together from a variety of social, economic and political perspectives, around the common belief that America s growing national debt threatens our future and that we must address it now with a comprehensive, bipartisan plan. The Campaign mobilizes key communities -- including leaders from business, government, and policy -- and people all across America who want to see elected officials step up to solve our nation s long-term fiscal challenges. The Sponsors gratefully acknowledge the generous support of The Judd and Kathy Gregg Family Speaker Series at Dartmouth College in making this event possible.