By David Pittman, Washington Correspondent, MedPage Today
Published: February 04, 2013
WASHINGTON -- Healthcare providers have an obligation to try new payment models that can help lower the growth rate of health spending, Health and Human Services Secretary Kathleen Sebelius said Monday.
"Far too many healthcare providers are still content to sit back and let others blaze the trail to a 21st century healthcare system," Sebelius said at the AcademyHealth National Health Policy Conference here. "My plea to all of you today ... is to help us speed up the rate of change."
But the change in care delivery and payment models isn't happening fast enough, Sebelius said.
"If you are already a vanguard of transforming care, now is the time to take the next step forward. If you've been considering participating in a new care model, now is the time to take the plunge," Sebelius said. "If you've been waiting on the sidelines to see actually how this is going to shake out, now is the time to get in the game."
"Some of our early results have been promising," Sebelius said, but she did not go into detail.
The healthcare system needs to move away from a fee-for-service model and begin to reward quality and outcomes, as do the pay models -- such as ACOs -- now being studied and implemented in the Medicare program.
The U.S. still spends 1.5 times more on healthcare than any other country. Medicare and Medicaid grow at rates much slower than the private sector, but they can still lead reform efforts, Sebelius said.
"History shows that innovations in how we pay for care often can begin with Medicare and then spread to the private insurance industry," she added.
Today, more than 250 ACOs exist, with more than 4 million Medicare beneficiaries getting their care from a provider whose bottom line is to keep them healthy. "These new models are spreading rapidly in states and the private sector," Sebelius said.
She also called for wider expansion of health coverage, particularly through Medicaid. Many states currently are debating if they should expand their programs to cover all those with incomes up to 138% of the federal poverty level. Under the ACA, the federal government will pay 100% of those newly eligible for the first 3 years, starting in 2014.
An expanded Medicaid can provide coverage for working families, reduce the burden of uncompensated care, increase productivity, and save lives, she said.
"They don't have to weigh the costs of going to the emergency room when their 5-year-old wakes up with a fever and there's no risk of losing everything you have when someone gets seriously ill and runs up a big hospital bill," Sebelius said.
However, states would be on the hook to pay for those currently eligible yet not enrolled in Medicaid, as well as for increased administrative costs and the remaining 10% of newly covered individuals when federal support wanes to 90% in 2020.
"There has never been a federal-state partnership that has looked anything like this," Sebelius said. "I'd say it's as good a deal as you're going to get."
Also, Sebelius mentioned the need to reach out to young people currently uninsured who may not know they can gain federal assistance to buy coverage through a health insurance exchange or marketplace. Young people are particularly tough to reach, she noted.
"If we're going to fulfill the full promise of the Affordable Care Act and insure millions of Americans, we need to reach these people," Sebelius said.