1150 Seventeenth Street, N.W., Washington, D.C. 20036
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Health reform relies heavily on Medicare for money to pay for insurance expansions and new ideas to bring down costs. The new law imposes $500 billion in Medicare cuts over the next decade, which could reduce seniors' access to care unless the program finds better ways to pay for and
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deliver health services. The Centers for Medicare and Medicaid Services (CMS) is creating hundreds of pilot projects to test new ideas that could be adopted programwide without further legislation--and could be adopted by private insurers and health systems as well. Can this approach succeed? What, if anything, has changed to improve on Medicare's past record of conducting experiments that have had limited success in enhancing the program's performance? A distinguished panel of experts, including current and past members of the Medicare Payment Advisory Commission and two former CMS administrators, will debate whether "past is prologue" in Medicare's latest efforts to save itself--and the health system.
| 9:00 a.m. |
| Registration and Breakfast |
| 9:15 |
| Presentation: |
| ROBERT BERENSON, M.D., Urban Institute |
| Panelists: |
| JOHN BERTKO, LMI Center for Health Reform |
| MARK MCCLELLAN, M.D., Brookings Institution |
| MICHAEL O'GRADY, National Opinion Research Center |
| GAIL WILENSKY, Project HOPE |
| Moderator: |
| JOSEPH ANTOS, AEI |
| 11:30 a.m. |
| Adjournment |
WASHINGTON, DC, OCTOBER 22--The new health reform law relies heavily on Medicare to pay for insurance expansions and bring down costs. The Centers for Medicare and Medicaid Services is developing hundreds of pilot projects to test cost-saving ideas, and some could be adopted programwide without further legislation. Health policy experts gathered at AEI to discuss Medicare's track record with these projects and future efforts to reduce costs and improve quality in health care. Speakers commented on the political challenges of designing Medicare demonstration projects and the program's role in health reform. They disagreed about its ability to expand Accountable Care Organizations and mentioned that certain demonstration policies may have unintended consequences.
- "What happens in Medicare is extremely important for our overall health care system, and there have been both positive examples of that and negative examples of that. And if you look at the Affordable Care Act, it clearly puts the lion's share of emphasis in achieving real health care reform--as reform that is going to lower costs while improving quality--on these efforts to make Medicare work better."
--Mark McClellan, M.D., Senior Fellow, Brookings Institution - "[We] need to think very carefully and thoughtfully about how the private sector and Medicare or Medicare and Medicaid can best work together--those areas where Medicare can lead and those areas where Medicare either must follow or should follow or politically is likely to be better off following."
--Gail Wilensky, Senior Fellow, Project HOPE - "The policy [to have Medicare use dynamic pricing for new services without evidence for a maximum of three years, after which it would revert to the reference price unless evidence of its superiority were produced] has a bias to services where there's a monopoly profit opportunity, meaning that there's a company with deep pockets that can fund the requisite evidence production. The idea is that you've got to go produce the evidence. . . . There are some services that don't have an owner: surgical procedures, a better care-management approach. So the question is, can comparative effectiveness research fill the gap?"
--Robert Berenson, M.D., Institute Fellow, Urban Institute
This article by Dr. Robert Berenson provides further analysis to supplement his remarks. - "One thing that makes me most enthusiastic about [Accountable Care Organizations] . . . is that there is a lot of energy on the physician and hospital side for this. They do want to do the right thing, and they are looking for reasons to do the right thing. The right thing, to start with, is to reduce hospital revenue."
--John Bertko, Senior Fellow, LMI Center for Health Reform - "To a certain degree, if all of the savings [from a demonstration] go--if there are plans, providers, patients, and the taxpayers--and all of the savings go to one of those four groups, you've set yourself up to build kind of a natural coalition against what you're trying to do."
--Michael O'Grady, Senior Fellow, National Opinion Research Center
--WISTAR WILSON
Joseph Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at AEI. He is also a commissioner of the Maryland Health Services Cost Review Commission and a health adviser to the Congressional Budget Office. Before joining AEI, Mr. Antos was assistant director for health and human resources at the Congressional Budget Office. At AEI, Mr. Antos's research focuses on the economics of health policy, including Medicare reform, health insurance regulation, and the uninsured. He has written and spoken extensively on the Medicare drug benefit and led a team of experienced, independent actuaries and cost estimators in a study to evaluate various proposals to extend health coverage to the uninsured. Mr. Antos is the coauthor of a recent AEI paper called A Better Prescription: AEI Scholars on Realistic Health Reform.
Robert Berenson, M.D., is an institute fellow at the Urban Institute and an expert in health care policy, particularly Medicare. From 1998 to 2000, he was in charge of Medicare-payment policy and private-health-plan contracting in the Centers for Medicare and Medicaid Services. Previously, Dr. Berenson was an assistant director of the Carter White House domestic policy staff and a member of the Obama transition team. He became a commissioner of the Medicare Payment Advisory Commission in July 2009 and its vice chair in July 2010. Dr. Berenson is a fellow of the American College of Physicians and a board-certified internist who practiced for twenty years, with the last twelve in a Washington, D.C., group practice. He also helped organize and manage a successful preferred-provider organization serving the D.C. metropolitan area. Dr. Berenson is coauthor, with Walter Zelman, of The Managed Care Blues and How to Cure Them (Georgetown University Press, 1998) and, with Rick Mayes, of Medicare Payment Policy and the Shaping of U.S. Health Care (Johns Hopkins University Press, 2006).
John M. Bertko is a senior fellow at the LMI Center for Health Reform, adjunct staff member at RAND Corporation, a visiting scholar at the Brookings Institution, and a visiting scholar at the Center for Health Policy at Stanford. He is also the retired chief actuary of Humana Inc., where he managed the corporate actuarial group and directed work by actuarial staff for Humana's major business units, including developing Part D, Medicare Advantage, and consumer-driven health care products. Mr. Bertko has extensive experience with risk adjustment and has served in several public policy advisory roles. He is currently on the panel of health advisers for the Congressional Budget Office and recently completed a six-year term on the Medicare Payment Advisory Commission. He was also a board member of the American Academy of Actuaries from 1994 to 1996 and vice president for the health practice council from 1995 to 1996. Mr. Bertko is a fellow of the Society of Actuaries and a member of the American Academy of Actuaries.
Mark McClellan, M.D., is a senior fellow, director of the Engelberg Center for Health Care Reform, and Leonard D. Schaeffer Chair in Health Policy Studies at the Brookings Institution. A doctor and economist by training, Dr. McClellan is a former administrator of the Centers for Medicare and Medicaid Services and former commissioner of the Food and Drug Administration (FDA). He was also a member of the President's Council of Economic Advisers and senior director for health care policy under George W. Bush. In these positions, he developed and implemented major reforms in health policy, including the Medicare prescription-drug benefit, innovative approaches to coverage in Medicaid and the State Children's Health Insurance Program, the FDA's Critical Path initiative, and public-private initiatives to develop better information on the quality and cost of care. Previously, Dr. McClellan served in the Clinton administration as deputy assistant secretary of the Treasury for economic policy, where he supervised economic analysis and policy development on a range of domestic policy issues. He was also an associate professor of economics and associate professor of medicine with tenure at Stanford University, where he directed Stanford's Program on Health Outcomes Research; associate editor of the Journal of Health Economics; and coprincipal investigator of the Health and Retirement Study. He has twice received the Kenneth J. Arrow Award for Outstanding Research in Health Economics. Dr. McClellan is the codirector of the Bipartisan Policy Center's Leaders' Project on the State of American Health Care; cochair of the Robert Wood Johnson Foundation Commission to Build a Healthier America; and chair of the FDA's Reagan-Udall Foundation. He is also cochair of the Quality Alliance Steering Committee, a member of the National Quality Forum's Board of Directors, a member of the Institute of Medicine, and a research associate at the National Bureau of Economic Research.
Michael J. O'Grady is a senior fellow in the Health Policy and Evaluation Department at the National Opinion Research Center and director of O'Grady Health Policy LLC, a private health consulting firm. From 2003 to 2005, Mr. O'Grady was the assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services, where he directed both the policy development and policy research across the full array of issues confronting the agency. Previously, he was the senior health economist on the majority staff of the Joint Economic Committee of the U.S. Congress, where his work focused primarily on Medicare reform, the uninsured, and other national health issues; and a senior research director at Project Hope's Center for Health Affairs. As a senior health adviser to the chairman of the Senate Finance Committee, Mr. O'Grady designed the Senate versions of key provisions of the Balanced Budget Refinement Act of 1999 and the Beneficiary Improvement and Protection Act of 2000, including Medicare+Choice and Medicare-covered drugs. Before joining the staff of the Senate Finance Committee, Mr. O'Grady was a senior analyst for the Bipartisan Commission on the Future of Medicare (Breaux/Thomas), the Medicare Payment Advisory Commission, and the Physician Payment Review Commission. He also spent several years with the Congressional Research Service (CRS) of the Library of Congress and the Office for Civil Rights in both the Department of Health Education and Welfare and the Department of Education. At CRS, he developed econometric and actuarial models of social legislation, including reform of the federal employee-pension system.
Gail Wilensky is an economist and senior fellow at Project HOPE, an international health education foundation. Most recently, she was president of the Defense Health Board. She has cochaired the Department of Defense Task Force on the Future of Military Health Care and been a commissioner for both the President's Commission on the Care of Wounded Warriors and the World Health Organization's Commission on the Social Determinants of Health. From 1995 to 1997, she chaired the Physician Payment Review Commission, and, from 1997 to 2001, she chaired the Medicare Payment Advisory Commission. In the early 1990s, she served as deputy assistant for policy development to President George H. W. Bush and was the administrator of the Health Care Financing Administration, directing the Medicare and Medicaid programs.
