October 2, 2017

Toby Cosgrove's 3 prescriptions for health reform

Daily Briefing

    Congress shouldn't work on another "repeal and replace" bill, but should instead focus on bipartisan solutions to fix three areas of the Affordable Care Act (ACA) "that will actually improve health care for all Americans": efficiency, drug costs, and population health, according to Cleveland Clinic CEO and President Toby Cosgrove.

    In a post for the Clinic, Cosgrove contends that any proposed fix should, at minimum, improve the exchange market and "maintai[n] the ACA's successes—widespread insurance coverage for Americans, guaranteed coverage for those with pre-existing conditions, and affordable access to coverage and care."

    But it also must address "escalating health care costs," Cosgrove writes. Cosgrove writes that curbing costs "isn't going to be achieved by any one law, reform, or sector." He outlines three key areas where the nation should start:

    1. Make health care delivery more efficient: To boost efficiency, Cosgrove argues that the government must focus on reducing the "number and complexity" of payment regulations; encourage rather than oppose hospital consolidation; and reimburse providers for new models of care delivery, such as retail and home-based care;

    2. Curb pharmaceutical costs: According to Cosgrove, the government should not only take "practical steps—such as use of value frameworks, streamlining the process for approval of generic drugs, group purchasing, and negotiating collaboratives— ... to keep prices under control without inhibiting free market competition," but it should also consider "common sense regulations to rein in price-gouging behavior on the part of some manufacturers"; and

    3. Invest in population health: "Ultimately, the best way to lower health care costs is to keep people well," Cosgrove writes, and that means the health care industry must encourage behavioral changes through "modest, but meaningful, financial incentives," such as lower co-payments or financial bonuses for weight management, smoking cessation, and other positive lifestyle decisions. As Cosgrove points out, curbing "obesity and smoking by just 10 percent could result in more than $20 billion annually in direct health care cost savings."

    According to Cosgrove, these investments have been shown to be effective at the Clinic, where "direct incentive programs have drastically reduced the costs to care for the 100,000-plus members of our Employee Health Plan."

    Cosgrove concludes with a plea to lawmakers: "Please don't launch further 'repeal and replace' efforts. Instead, work across the aisle, transparently and publicly, to sustain a high-quality American health care system through efficiency, accessibility, affordability, and wellness" (Cosgrove, Cleveland Clinic Newsroom, 9/27).

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