'Person-centered' care at heart of new reform plan

A new "person-centered" healthcare framework incorporating Medicare, Medicaid and insurance reform could improve care and save $300 billion over the next decade--and more than $1 trillion over 20 years, a new report from the Engelberg Center for Health Care Reform at The Brookings Institution concludes.

The report, "Person-Centered Health Care Reform: A Framework for Improving Care and Slowing Health Care Cost Growth," part of Brookings' "Bending the Curve" series, recommends ditching fee-for-service payment models in favor of "paying for coordinated care that meets each patient's needs," including through a program known as Medicare Comprehensive Care (MCC), Brookings says in the executive summary.

The framework "weaves together approaches to reform that are showing promise in different parts of the health care system, while avoiding cost-shifting or disruptions in the care that patients receive," the summary says.

"We want (existing) steps to reform health care to accelerate, and the time is now to implement a full-scale, step-by-step plan to make that happen," former Sen. Tom Daschle, a senior policy adviser in DLA Piper's Government Affairs practice, says in an announcement. "Medicare and the rest of our health care system are not yet on sound footing from either a quality or cost standpoint, and we risk a future of continued reliance on short-term cost controls or cost shifting that have not, and cannot, get us to more sustainable, innovative care."

Under Medicare Comprehensive Care, provider teams coordinate care and receive a single payment tied to quality of care and patient outcomes, according to the report. Among Medicare payment reforms, providers receive financial incentives for mobilizing to improve care and lower costs. Medicare benefits are modified, and beneficiaries are protected against high costs under Medigap. MCC would be phased in over 10 years.

The report also proposes moving Medicaid toward a financing system "tied to better care and lower cost growth on a per-beneficiary basis." States would share in savings when they achieve those goals. A comprehensive federal infrastructure would be in place to help state reform efforts, the summary notes. At the same time, the report recommends limiting the exclusion of employer-provided health insurance from taxable income by imposing a cap that would grow at the same per-capita rate as federal subsidies in Medicare and the insurance marketplaces.

"We didn't come into this looking to change just one piece of the system based on our own personal agendas or beliefs,"  Michael Leavitt, former secretary of the Department of Health & Human Services, says in a statement. "We found that the most important common ground was on supporting better care for patients, and our plan needed to span the entire system to achieve that goal, with specificity about changes that can start happening now."

The idea of person-centered care has been gaining steam. The concept often is used to guide care of elderly or frail patients in assisted living by giving them choices in their daily schedules, but it is spreading into the greater healthcare arena.

Writing in Forbes last fall, Urban Institute fellow Howard Gleckman defined the concept as "doctors asking patients about their goals–and paying attention to what they say–and sharing decisions with people who have no medical training. … This kind of care requires doctors, nurses, and social workers to take the time to get to know their patients and what they want."

To learn more:
- download the report (.pdf)
- read the executive summary
- here's the announcement
- check out the Forbes column