The Business Roundtable is comprised of large companies, which in aggregate have $16 trillion in revenue and employ 16 million workers and provide health care coverage to 40 million people. Health care benefit costs and worker productivity are obviously topics of interest to this group and they have produced a report on innovation in health care. (BR Report) The report begins by noting the adverse economic effects of high health costs and spending growth, both in the private sector but also in regard to the tax burden of providing government-funded health care, such as Medicare and Medicaid. From 2002 to 2013 average private insurance premiums, family and single, grew at an almost 300% rate. As might be expected, the report highlights market-oriented solutions, including greater price transparency and incentives for consumers to choose lower cost and/or higher quality providers. This requires better data collection and reporting from providers and education and support for consumers. The report gives numerous examples of efforts undertaken by Roundtable members along these lines. In regard to data collection, the report properly notes the importance of being able to create all-payer databases and reports, and the need for government programs in particular to release this information. Price and utilization data needs to be coupled with quality metrics, especially on actual health status impact, not just process measures, which may or may not reflect real effects on a patient’s health status. The development of decision support tools that display information in ways that are most likely to help a consumer is also an important step.
The report also notes the need for greater regulatory flexibility in regard to wellness and benefit design, with an ability to reward healthy behavior, deter unhealthy conduct and steer patients toward providers who have demonstrated good quality outcomes at a reasonable price. This would require elimination of any willing-provider laws and limits on certain benefit designs. The report also calls for greater efforts to reform malpractice laws to reduce incentives to practice defensive medicine, ensuring use of medical directives and other techniques aimed at controlling end-of-life care, encouraging use of non-physician providers by expanding scope of practice laws and removing barriers to use of telemedicine, which generally has lower unit costs. The report is a nice wish list and certainly identifies things that would make a difference, but it is a little short on what tactically can be done to remove the political impediments to real change.