National Academy Of Social Insurance Panel
For Immediate Release: January 28,1998
Contact: Jill Braunstein at (202) 452-8097
WASHINGTON, DC -- Amid continuing public debate on the future of Medicare, a blue-ribbon panel of experts today proposed sweeping reforms to inject innovation into the traditional "fee-for-service" part of the Medicare program as it heads into the 21st century. The panel's membership is drawn from medicine, public policy, law, and industry, bringing together a wide range of perspectives to help chart the future direction of Medicare.
At the heart of the panel's recommendations, which are spelled out in a new report released by the National Academy of Social Insurance, lies the belief that modern techniques from the private sector and elsewhere can reduce costs and improve services for fee-for-service Medicare. However, legal and political barriers prevent the program from innovating in a timely fashion.
According to the Academy's panel, Medicare must move beyond its traditional role as simply a payer of health care bills to become accountable for the quality and costs of services provided to beneficiaries. That transformation should be explicitly mandated by Congress, the panel concludes. Congress should direct Medicare to experiment on an ongoing basis with new methods developed in the private sector for providing and managing services. Those methods include disease and case management for people with chronic illnesses or other conditions; incentives for beneficiaries to select providers who demonstrate superior quality and effectiveness; and competitive procurement procedures.
"The modernization of fee-for-service Medicare is critical," said panel Chair Paul B. Ginsburg, president of the Center for Studying Health System Change. "Despite growing enrollment in Medicare's private managed care program, fee-for-service Medicare is and will remain the dominant means for delivering services to Medicare beneficiaries well into the future."
"Medicare's fee-for-service program is responsible for serving some of the sickest and most vulnerable people in our society," said Ginsburg, "but it is unfortunately behind the times in organizing services for those people. It needs to test and adapt new ways of organizing, delivering, monitoring and paying for services, while preserving a broad choice of providers, especially for people with special health needs."
The panel notes that services provided under Medicare for beneficiaries with chronic conditions like congestive heart failure, lung disease, diabetes, arthritis and hypertension, or with other special health needs like end of-life care, have been fragmented and uncoordinated. Innovations in case and disease management and preventive services could bring about important improvements in care for those beneficiaries and help to manage costs better, the panel notes.
The study panel also concludes that Medicare's current demonstration waiver authority is far too limited to support the culture of learning and innovation that fee-for-service Medicare requires.
The panel's specific recommendations include the following:
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