Institute of Healthcare Improvement calls for changes to make new health law succeed

WASHINGTON—Better coordination among doctors and hospitals. More transparency in medical costs and outcomes. New models of care, like sharing your doctor’s appointment with a small group of patients suffering from the same condition.

These are among a litany of critical checkpoints that need to happen, healthcare leaders say, to take the country from the post-election relief many advocates of health reform felt to making the 2010 law to expand health care access a success.

The Institute for Healthcare Improvement released a report Wednesday outlining the path hospitals, doctors, insurers, and states need to take to bridge the gap between the care that now exists and the care that health reform is striving for. The Cambridge-based institute was headed by Dr. Donald Berwick, who until last year had been Obama’s administrator for the Centers for Medicare and Medicaid Services.

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The recommendations stemmed from a November conference that drew more than 100 health care leaders to Washington to discuss what President Obama’s re-election two days prior signaled for the future of American health care.

“The recent election, despite yielding no change in the political balance of power in Washington, had fundamentally altered the landscape of health care,” the report said.

The challenges are great, the statistics sobering, it said. More than 100,000 deaths each year result from preventable medical errors. About 48 million Americans remain uninsured. Health care accounts for more than 17 percent of GDP and is rapidly rising.

In coming weeks, states must decide whether to run their own insurance exchanges—an online marketplace for consumers to shop for and compare health plans—or partner with or leave the creation of exchanges to the federal government. They also must decide whether they want to participate in the expansion of Medicaid.

So far, only six states are on track to meet the deadline to have exchanges in place by October 2013. The Centers for Medicare and Medicaid Services announced on Monday that it has approved the plans of Massachusetts, Colorado, Connecticut, Maryland, Oregon, and Washington to set up state-based exchanges. Altogether, 14 states have indicated plans to set up state-based exchanges, said CMS officials on a conference call with reporters.

There is no deadline for states to let the federal government know about whether they intend to expand Medicaid, said Cindy Mann, director of the Center for Medicaid and CHIP Services.

Given the current fiscal cliff debate and potential cuts to so-called entitlement programs, some health experts worry that states may be hesitant to expand Medicaid because of concerns that the guarantee of federal matching funds is less than airtight.

The report suggested a dramatic overhaul to address the waste, poor coordination, and suboptimal care for the 9 million Americans now covered by both Medicare and Medicaid, the “dual eligibles.”

It also pointed to the pressing need to change how doctors and hospitals are paid, urging a faster transition from insurers paying for each procedure to rewarding providers for holding down costs. For change to occur on a large enough scale, Medicare may need to take the lead, the report said.