By TANISHA CARINO

Medicare could immediately modernize its benefit structure by incorporating value-based insurance 
design (VBID) into the Part D program.  This benefit design tool maps directly to the new Administration’s goals of improving quality and preventing complications of illness—and, as I’ll point out, it can be implemented without any new legislation.

VBID abandons the traditional approach of uniformly applying cost sharing to health services regardless of their effect on a patient’s health.  Instead, VBID tailors cost sharing—so, the more clinically beneficial the service is to a patient, the lower that individual’s cost sharing for the service.  In some cases, employers such as Marriott and Pitney Bowes have actually eliminated cost sharing associated with diabetes medications and achieved positive cost and quality outcomes.

With more than 26 million enrollees, Medicare Part D is a large target for this type of innovative, quality-focused benefit design.  The 23% of Medicare beneficiaries who have five or more chronic conditions account for 68% of the program’s spending, and there is heavy reliance on medication to treat chronic illness.

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According to ConnextionsHealth, growing losses of
individual and group plan members are eroding acquisition costs,
profitability and competitive advantage at all major health plans,
making member retention a strategic priority for 2009. At some health
insurers, member turnover is running as high as 40%. Further, McKinsey
& Co. found that health plans capture less than 10% of members lost
through job termination, early retirement and elimination of
employer-funded coverage. This “employee transition” market segment
alone is estimated at $40 billion annually.To address this
emerging market need, ConnextionsHealth and World Health Care Congress
are hosting a first-of-its-kind Leadership Summit on Member Retention
for Health Plans scheduled for March 18-19, 2009 in Orlando, FL. 
Designed for health plan senior executives, the Summit will provide an
insider’s look into the underlying issues and successful strategies for
retaining individual and small group plan members and building brand
loyalty. More information is available at www.worldcongress.com/retention.

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By Val JONES MD

Rumor has it that Sanjay Gupta
is no longer in the running for the office of Surgeon General. Many
peopl
e had voiced their concerns about his potential nomination
(including Paul Krugman, Maggie Mahar, Gary Schwitzer, Dr. David Gorski, and myself)
and it looks as if his lack of experience or training in matters of
public health, along with a history of industry ties has put the kabosh
on his nomination.

So who will be our next Surgeon General? It’s hard to say, but a petition is circulating on behalf of Dr. George Lundberg – a fine nominee for the position in my opinion. Let me explain why.

A review of Dr. Lundberg’s curriculum vitae easily
establishes his professional qualifications for the position. Not only
has he been one of the longest standing Editors-In-Chief of all the
American Medical Association journals (including JAMA), and the founder of the world’s first open-access, peer reviewed online medical journal (Medscape Journal of Medicine)
but has served in an advisory capacity to everyone from the World
Health Organization, to AHRQ, the Joint Commission, Harvard’s School of
Public Health, the Department of Health and Human Services, Food and
Drug Administration and the Surgeon General of the US Navy. He is also
a prolific and influential writer, having authored 149 peer-reviewed
articles, 204 editorials, and 39 books or book chapters. Dr. Lundberg
has a large and devoted national and international audience and is
highly esteemed by all who know him.

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