CAP’s Blueprint for reform

The Center for American Progress (CAP) released a new “Blueprint for Reform” that focuses on how to fix the delivery system. This well-constructed
document and provocative forum was spearheaded by CAP CEO John Podesta (former Clinton White House Chief of Staff) and Jeanne Lambrew.

There are a few things that really show good progress in the
national debate. First, the fact that CAP has chosen this critical time
at the precipice of the national health care reform debate to focus
attention on reforming care as well as coverage will be helpful to
facilitating that discussion in 2009 policy debates (they, of course,
support coverage initiatives as well but those aren’t addressed in this

Second, the quality and thougtfulness of the work and recommendations is high. Not surprising given the exceptional collection of authors with each chapter co-authored by a physician and a policy expert. These
include: Don Berwick, Tom Lee, Judy Hibbard, David Blumenthal, Bob
Berenson, Paul Ginsberg, Steve Schroeder, Dora Hughes, Chiquita
Brooks-LaSure, Karen Davenport, and Katherine Hayes.

Finally, it was encouraging that CAP identified patient
activation/second-generation consumer engagement as one of the six
domains (chapters) that must be addressed in a reformed delivery
system. The authors define second-generation consumerism as “engaging
and activating patients to better manage their health,” which
represents an important step beyond just throwing information at them
and making them financially accountable for their health care
spending–which, as the authors point out, research has shown doesn’t
really accomplish the things we want.

What I would like to see CAP do more of in the future is better
integrate that patient activation component into the infrastructure
section (not surprisingly, much of what the IxCenter works on). To be
specific, many of the opportunities for engaging and activating
patients need to be better embedded into the health care delivery
system infrastructure. That means not just giving consumers access to
personal health data via electronic tools, but actually creating them
in such a way that they allow consumers to engage and enhance

Hopefully, that detail can be built into future CAP work and next year’s health care reform debate.

Joshua Seidman is the president of of the Center for Information Therapy
that aims to provide the timely prescription and availability of
evidence-based health information to meet individuals’ specific needs
and support sound decision making.

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2 replies »

  1. Peter asks good questions.
    Look- in order to get our health-system in order, to be able to successfully provide health-care to the millions who will hopefully become part of the population of insured, we need a comprehensive and unified health care system. The Executive branch should be the organizing power and Congress must give the rubber-stamp. In several years, the extra funding that that needed to jump-start this new infrastucture will get return in the huge dividends from reduced waste (less paperwork, less un-necessary procedures–> decreased health care costs).
    The Obama administration should work to build an enduring, health care institution. It should encompass at least these 3 broad objectives:
    1)A secure, nationalized health records database, accessible to all U.S. hospitals and to licensed physican’s offices. It is a huge but essential undertaking that would be an enormous reducer of medical waste and medical errors.
    2) A single-payer National Health Insurance (NHI), modeled as an extension of the Medicare system and including a federal government oversight body. The body would be able to decide on standard reimbursement schemes which would un-shackle hospitals and clinics from the burdens of fragmented insurance coverage. A NHI would also force continuous, public scrutiny of the insurance-related market forces that drive a lot of hospital investment decisions. We know that hospital investments in high-tech care, for example, do shape future trends in behaviors like, what procedures are chosen for patients and what imaging studies are ordered to make diagnoses.
    According to PNHP, bureaucracy consumes 31 percent of US health spending, versus 17 percent in Canada. David U. Himmelstein and Steffie Woolhandler argue that this
    difference translates into $350 billion wasted, annually, in the U.S., where hundreds of thousands in the insurance industry, spend their days on useless paperwork.
    3) A broad, public educational initiative, vocalized in Presidential public messages, schools, and major networks, about the essential, preventive measures that can be taken to reduce incidences of the major- modifiable diseases that burden our system: cardiovascular disease, diabetes, and stroke.

  2. “The prospect of expanded health care coverage is one of the dynamics forcing policymakers to re-examine our health care system’s infrastructure. Universal coverage without a health system prepared to serve a larger insured population could rob health reform of its promise and its benefits. However, simply providing more of the same resources, organized as they are today, would also be a mistake. Health care is changing, and the health system’s infrastructure must change with it.”
    But they don’t say how we get there from here. Who organizes all this and executes these changes? Somebody will have to be the bully pulpit AND have the power of funding to enact all of this – who will that be?

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