Summit moderator Dennis Scanlon, PhD, asked the panelists to sum up their thoughts from the day’s discussions.
“At this point, the [Centers for Medicare & Medicaid Services] and the [Center for Medicare Innovation] in particular should ratchet back” their efforts, declares Francois de Brantes, executive director of the Healthcare Incentives Improvement Institute. He sees their efforts as too many fits and starts, and although they have moved the needle on reform, none of the individual initiatives can be rated “a stellar A.” Over the next 4 to 5 years, innovations in the private sector will serve as a primary engine and the federal government can learn what works with the models as they evolve, he adds. The delivery system can be fully transformed when other innovations emerge, and we will learn from that, predicts Mr de Brantes.
There is no final solution so far regarding healthcare costs, according to Arthur Vercillo, MD, FACS, regional president of Excellus Blue Cross Blue Shield, although the ACA has led to consumers having more skin in the game, which he believes will make a difference. However, the real game is to maintain or improve the quality of healthcare while holding down costs. “We know what the cost drivers are, and they need to be attacked individually,” he states.
Even though accessibility with the ACA is progressing, Dr Vercillo says we are not there yet, although over the next few years “We’ll be in a much better place when it comes to quality, cost and accessibility, and we need to.”
Ateev Mehrotra, MD, MPH, associate professor of healthcare policy and medicine at Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center agrees with Mr de Brantes’ assessment of the ACA approach of trying different avenues to manage healthcare spending. He points to patient-centered medical homes, which sound rational in theory but have not had much of an impact. “We just can’t go based on theory anymore. We have to say, ‘Okay, the evidence is that a particular intervention didn’t work. Maybe ACOs did work. Let’s put more of our energy there.’” We must eliminate programs that are not working, he emphasizes.