Beyond ACA repeal and replace: Health experts issue a blueprint to make American healthcare great again

Signs saying healthcare reform
A new report by the National Academy of Medicine provides a roadmap to make healthcare in America great again. Photo credit: Getty/Eugenia Chaikina

While Congress continues to hash out the details of a GOP bill to repeal and replace the Affordable Care Act, leading public health experts say the debate fails to address the actual challenges to American health and healthcare and will have a limited impact on the health of the population.

The National Academy of Medicine (NAM) has released a new discussion paper (PDF) that goes beyond the debates over insurance coverage and creates eight policy directions that are essential to advance American health, healthcare and scientific progress.

The publication is part of NAM’s Vital Directions for Health and Health Care Initiative, which called together more than 150 leading experts 18 months ago to examine ongoing healthcare problems, including high costs, disparities in health and the burden of chronic illness and disability.

The report was written by a bipartisan steering committee, which included Mike Leavitt, former governor of Utah and former secretary of the Department of Health & Human Services; Mark McClellan, former commissioner of the Food and Drug Administration; and Tom Daschle, former Senate majority leader.

“In the midst of all this debate, we cannot afford to lose focus on the ultimate goal of achieving better health for all, for an effective healthcare system that not only helps people prevent and treat their ailments but also helps every American to reach their best health and well-being,” Victor J. Dzau, M.D., co-chair of the committee and the president of NAM, said Tuesday during a conference to unveil the findings.

To achieve this goal, McClellan said the report identifies four priority actions to advance a more efficient and patient-focused health system, as well as four infrastructure needs to support the system.

Priority actions

Pay for value: One of the recurring themes in the 19 papers released as part of the report is the problem with the nation’s fragmented payment system. The report describes the need to align payments with outcomes and results and focus on activities that deliver the best outcome for patients at the lowest costs. To advance value-based care, policy reforms must drive healthcare payment and innovation providing incentives for outcomes and value, help clinicians develop the core competencies required for new payment models and remove barriers to integration of social services with medical services.

Empower people: Healthcare needs to be more democratic, McClellan said. The report calls on policy reforms to encourage clinicians to work with patients and families to ensure the care they provide matches the individual’s goals, work to improve health literacy and communicate in a way that is more understandable to patients, promote effective telehealth tools, and ensure patients have access and ownership of their personal information.

Activate and support communities: In most cases, health is determined by where patients live, what they are exposed to and who they spend time with, according to McClellan. Therefore, the report recommends strategies to support stronger, healthier communities, such as investing in local leadership and infrastructure for public health initiatives, expanding community-based strategies that target high-need individuals, such as patient-centered medical homes, and utilizing resources at the local level to customize and scale community health innovations.

Connect care: McClellan said the final action involves creating principles and standards for end-to-end interoperability, which involves making necessary regulatory and infrastructure changes for clinical data accessibility and use, and identifying information technology and data strategies to support continuous learning.

Essential infrastructure needs

To drive these actions, the report calls for different infrastructure needs, such as:

Measure what matters most: This means a consistent set of core measures must be developed. The report calls on HHS to identify a lead organization for each of the 15 core measures, and ongoing investment in improving performance measurement.

Modernize skills: The country must invest in and train the healthcare workforce to manage increasingly complex patients and populations. This will require reforms in healthcare training and education.

Accelerate real-world evidence: There is much promise in the potential to analyze large amounts of health-related data from actual patient care. But the report says progress has been hampered by technical, regulatory and cultural barriers. Policy reform must draw on real-word evidence to advance continuously learning clinical research, create incentives and standards that foster a culture of data sharing, and partner with patients and family to support evidence generation and sharing of information.

Advance science: To advance the pace of innovation, policies must invest in scientific innovation, support collaboration among government, academia and industry scientists, and streamline regulatory processes.