• Curbside consult: Can we control spending and improve quality of care?

    chernewpicI taught at the University of Michigan School of Public Health for many years. Not every day, but many days, Mike Chernew and I would wander to the student lounge on morning soda break, and discuss great issues of the day. I learned a heck of a lot about health economics and other matters in these conversations.

    Bad screen-shot of video taken by iPhone.

    Bad screen-shot of video taken by iPhone.

    Life moved on, and so did we. Michael is now a star, though I run circles around him in the blogging space. He’s an elected member of the Institute of Medicine, and he’s has won other fancy awards. He is now Professor of Health Care Policy in the Department of Health Care Policy at Harvard Medical School. His research examines several areas related to controlling health care spending growth while improving quality. He has worked with large employers on Value Based Insurance Design (VBID). His work on payment reform involves evaluation of bundled payment initiatives, including global payment models and pay-for-performance. He has also done important research concerning the likely impact of changes to Medicare Advantage payment rates and the design of essential health benefits under health reform. Mike is also Vice Chair of the Medicare Payment Advisory Commission (MedPAC).

    We sat down for a long video conversation about bundled payment, Medicare cost growth, cost-effectiveness, and various other matters.*

    Of course, Mike’s comments are his personal opinions and do not represent the views of MEDPAC or any other organization with which he has worked.

    I believe faithful TIE readers will enjoy my conversation with Mike, of course acknowledging that he does not bring the sheer personal magnetism and electricity that Aaron Carroll and Austin Frakt provided in previous interviews.

    *Link fixed.

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    • Excellent questions by Pollack, not so satisfactory answers from Chernew. I was expecting helpful guidance as to what the medical profession considers an “essential health benefit”, so I would be an informed consumer when I purchase a health insurance policy. Those expectations have been dashed. Chernew believes it’s a cost issue, but that’s true only if the sole policy consideration is universal coverage achieved through subsidized private insurance. What about everybody else? Of course, the Obama administration punted on the issue of “essential health benefits”; it’s revealing that the Obama administration made it a political spectacle to include birth control pills as an essential health benefit, while Chernew kept using fertility treatments as a luxury that isn’t. Good grief, can’t we leave sex out of it! The failing here belongs with the medical profession. Why hasn’t the profession developed sufficient protocols so that “essential health benefits” could be established for a given profile (age, etc.). Framing health care policy according to what the government can afford to provide for the least among us is not good policy.

      • “The failing here belongs with the medical profession.”

        What makes you think it is the medical profession’s job? If one builds and pays for a bridge it is that entity that decides how much to spend and what the bridge should include (as long as the law is observed). The engineers can only provide advice based upon their experience and training. In the end the one paying the bill calls the tune as that entity is the one in need and knows how much money is available to pay for the project.

        Do you think it should be any different in healthcare? I don’t think anyone is able to provide a reasonable answer to tell us what basic healthcare should cover and how in all circumstances. What is basic to one individual seems to be considered a luxury by another. What might be needed by one individual might not be needed by another.