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Getting to Health Care Affordability: Dr. Zeke Emanuel’s Top Four Strategies

Posted By Louise Probst, Wednesday, August 7, 2019

Last week, I had the opportunity to listen to Dr. Zeke Emanuel, an accomplished clinician, health policy expert, and key architect of the ACA (bio here), during an interview at the 2019 Optum Forum. When asked what health care advice he would offer the next administration, he said that he had four “low-hanging fruit” strategies that could be undertaken on the administration's first day for meaningful impact:

  1. Cap hospital prices for commercial payers at 140% of Medicare (a more than adequate payment for any hospital).

  2. Enact an immediate 10% reduction in drug prices. While not as large of a reduction as needed—the U.S. would still remain the nation with the highest drug prices—it would reduce spending by about $50 billion annually, or almost $700 per family.

  3. Require standardized claims forms and administrative procedures across carriers to achieve seamless claims processing, freeing up administrative waste and aiding physician offices.

  4. Require all insurers who participate in Medicare or Medicaid to have at least 50% of their payments across all products be an alternative to fee-for-service, with upside and downside risk.

Dr. Emanuel’s recommendation to cap hospital payments from commercial plans at a percentage of Medicare is getting a lot of traction among state employee benefit plans. With two years under their belt, Montana’s state employee program is leading the way, and Oregon’s plan is starting this fall. North Carolina, supported by the State Treasurer, is in the throes of a very public debate that has seen substantial pushback from hospitals that say they will go out of business.

 

Join other BHC employers for the August 13th Member Meeting to see the results of a recent national study by RAND Corporation of commercial plan payments as a percentage of Medicare, including all of St. Louis’ major hospitals. The lead study author, Dr. Chapin White, will also discuss opportunities for employers to apply this data to benefit plan strategies to achieve higher value. We hope to see you there in-person or via our webinar option (please contact Todd Boedeker with registration questions).

 

Warm regards,

 

Louise Probst

BHC Executive Director

 

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