Partisan divisions on health care have become deeply entrenched over the past two decades, with stalemates on basic questions such as who should pay for health coverage and the role of government in ensuring access to care. The bitter clashes over the Affordable Care Act—including more than 60 congressional attempts to gut the President’s signature health care initiative—deepened this divide and were on full display in a presidential race in which every democratic candidate promised to protect the law, while every republican candidate vowed to repeal it.
But beneath the partisan rancor is a movement that leaders of all political stripes and a broad range of stakeholders have embraced to improve the value we get for our health care dollars and slow the growth in costs before health care expenditures threaten our nation’s prosperity. All agree this requires realigning financial incentives and reconfiguring the way care is provided to achieve the Triple Aim: improved patient experiences of care, improved population health, and reductions in per capita health care costs.
This pursuit, in turn, has spurred an unprecedented amount of innovation in both the public and private sectors and at all levels of the health care system. Payers—employers, commercial insurers and public programs such as Medicare—are shifting from reimbursing doctors, hospitals, and other providers based on the volume of services they provide to rewarding quality and improved outcomes. Likewise, care providers are experimenting with new models that, among other things, coordinate services for patients with chronic conditions, engage patients in their own care, use interdisciplinary teams to make treatment decisions, and partner with community organizations to address the social determinants of their patients’ health, such as access to affordable housing, safe communities, and healthy foods.
The Affordable Care Act accelerated this trend by advancing alternative health care payment and delivery models, but this movement began long before the law’s passage. Pilot programs conceived during both Republican and Democratic administrations have sprouted up in urban, rural, and suburban areas, across the continuum of care, and in red, blue, and purple states. Health care experts have coined the phrase “delivery system reforms” to describe these new models, though this prosaic term belies the dramatic changes unfolding in an industry historically slow to adapt.
Several Aspen Institute initiatives support this transformation. The Health, Medicine, and Society Program, for example, is laying the groundwork for a multi-year initiative designed to help sustain, spread and scale successful delivery system innovations; and a number of Aspen Institute leadership programs bring together entrepreneurs and innovators committed to tackling health care and other societal challenges.
Last year the Institute partnered with Greenville Health System to launch the Health Innovators Fellowship, which challenges health care leaders to create new approaches to improve the health and well being of Americans. Fellows from the first two classes include individuals who have spent years in the trenches of delivery system reform as well as health leaders who are using the support of the fellowship to undertake new ventures that reconfigure how care is provided to tackle racial disparities in health outcomes and improve hospital quality and safety, among other goals.
“At the Resnick Aspen Action Forum in July, Dr. Amy Crockett, a physician participating in the South Carolina-based Liberty Fellowship, another such leadership program, was recognized as a 2016 laureate of the John P. McNulty Prize for an innovative prenatal care program that she implemented through the Fellowship.” Centering Pregnancy promotes pregnant women’s engagement in their own care through group visits with women who are due to have babies at the same time, a low-tech intervention that has reduced the rates of preterm births by 47 percent among its participants and narrowed the racial disparities in health outcomes in her Greenville, South Carolina practice. This innovation has the potential to move the needle nationally on health care outcomes, especially if scaled and spread to other parts of the country and applied to other medical conditions.
In spite of these promising developments, we are years away from achieving the kind of high performing system that Americans expect and deserve. To maintain the momentum, the next president, regardless of party affiliation, must work with lawmakers on policies that encourage innovation and enable successful models to flourish. Areas ripe for bipartisan support include:
- Continued experimentation with new payment and delivery models coupled with rigorous evaluations and effective methods for getting the results of those experiments in to the field;
- The further transformation of Medicare from a passive payer of services to an active purchaser of high quality care; and
- Support for states and localities to create local information exchange networks that are critical to ensuring providers can manage their patients’ care.
Once we get past the 2016 elections, our political leaders can abandon the reductive health care slogans, roll up their sleeves, and work together to accelerate the transition to a value-based, efficient health care system—something upon which we can all agree.