Senator Baucus on Delivery System Reform
Professor Tim Greaney
Director, Center for Health Law Studies
Chester A. Myers Professor of Law
Saint Louis University School of Law
Senator Baucus’ March 3 press conference sponsored by the Kaiser Family Foundation Health Care Reform Newsmaker Series: Sen. Max Baucus (D-MT) offered a few insights into the early state of the debate on health reform legislation.
Two points stood out. First, he observed that “delivery reform” was for him a central element in designing reform legislation. Pressed to define what he meant, Baucus mentioned value based purchasing and the medical home concept. Second, he stated that the tax exclusion for employer health insurance payments was on the table, noting two characteristics that make it an appealing target: regressivity and potential source of considerable “revenue.” On these and other issues, Baucus stressed the critical role OMB scoring will play in shaping the ultimate design of the legislation.
The known unknown here, however, is how some of the relatively novel delivery reforms like medical homes will be defined and implemented — and hence ultimately scored by OMB for their impact on system costs. One problem is that the “medical home” may encompass a wide range of delivery/financing arrangements. In general the medical home has been broadly defined as a physician-directed practice that provides care that is “accessible, continuous, comprehensive and coordinated and delivered in the context of family and community.” But as Bob Berenson and colleagues pointed out in Health Affairs last September,[1] few primary care medical practices are close to having the size, management capabilities and infrastructure (electronic and otherwise) to function as medical homes. Transitioning to such practices (even on a virtual office basis) will surely take time, money, and a sea change in culture and practice style. Estimating the pace and effectiveness of such change may prove as daunting as projecting next months Dow Jones average.
[1] Robert Berenson et al., A House is Not a Home: Keeping Patients at the Center of Practice Design, 27 Health Affairs 1219 (Sept/Oct 2008)
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