Outgoing HHS Secretary touts successes, says more work must be done

Improving quality of health care and ensuring access to it should be priorities of the next administration, outgoing HHS Secretary Sylvia Mathews Burwell wrote recently.

“The American people do not want to turn back our nation’s progress,” Burwell wrote in a blog post that appeared on the Health Affairs website. “Improvements need to be made, but they need to build on progress and not take us backwards in terms of access (the number of insured), affordability (costs to individuals, businesses, and taxpayers), and quality (the benefits that are being provided).”

Sylvia Mathews Burwell

Burwell wrote that delivery system reform, in which providers work jointly to create a coherent care experience, is critical to making the vision of improved, quality health care a reality. Reforms should also allow providers to be rewarded for cost-saving measures, and to be flexible and innovative. She outlined three parts of a strategy to set this plan in motion.

Change the way payments are made

The Accountable Care Organizations’ approach of having groups of health care providers assume responsibility for patient costs and quality of care and then these providers share in the savings, is one example of an innovative approach to revenue generation, Burwell wrote. Another is the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), with its tools that reward quality over quantity, that should significantly reformMedicare payments. Burwell said a goal of 30% of Medicare payments made in alternative payments was reached nearly a year ahead of time, and plans to increase these payments to 50% are on schedule as well.

“Implementing MACRA has just begun, and we know questions will continue to arise regarding whether we have sufficiently tailored the program to support small and rural practices, or whether there are enough alternative payment models available,” Burwell wrote. “To address these challenges, we plan to continue working closely with clinicians and patients, listening to their concerns and ideas, and responding to their feedback.”

Improve delivery of care

The second part of the strategy would allow primary care providers to practice the way they think is best, and eliminate some of the gap between cost and quality among different providers, Burwell wrote. Referring to the Comprehensive Primary Care (CPC+) as an example, she touted the flexibility and monthly care management fees it gives doctors.

“We know it’s a long road ahead,” Burwell wrote. “Transforming the delivery of health care is a difficult process. Even the first step of measuring quality is a challenge — constructing valid measures with data from small patient populations can be difficult, and information systems are often not standardized.”

Unlock Health data

Finally, health care data must be mobile, hospitals and doctors must understand that patients have a right to their own electronic health information and patient data must move securely and easily throughout the health care system, Burwell wrote.

“It’s important to stay clear-eyed about the difficulties we face in unleashing health data. It is time-consuming and expensive to ensure that different systems are compatible. Changing the culture is easier said than done. And even when data can move more freely, it’s not always perfectly accurate or useable,” Burwell wrote, adding the idea is gaining momentum, with 96% of reporting hospitals having certified electronic health record technology.

“All of this work is worth it, because we all benefit from a system that measures outcomes and rewards value,” Burwell concluded. “We all benefit from care that centers on patients and enables them to take a greater role in their health care. And our businesses and the entire economy benefit from a system that is more efficient and more effective.”

Disclosures: Burwell is an employee of the HHS.

Further reading:
http://healthaffairs.org/blog/2016/12/12/building-a-system-that-works-the-future-of-health-care/