From: Reuters
Published May 29, 2008 04:45 PM

U.S. health insurers pitch policy changes

By Kim Dixon

WASHINGTON (Reuters) - Major U.S. health insurers on Thursday pitched several clinical and payment policy changes, adding their voice to a growing debate over reforming the nation's costly and often inefficient health care system.

America's Health Insurance Plans, a trade group for major players like Aetna Inc and UnitedHealth Group Inc , said its proposals, if implemented, could shave $145 billion off the nation's $2 trillion-a-year health care tab.

Health care spending is now about 16 percent of the gross domestic product, and likely to top 20 percent by 2017, according to the U.S. Centers for Medicare and Medicaid Services.


The trade group's cost savings estimate was blessed by consultants at PricewaterhouseCoopers.

Escalating costs and limited access to quality medical care in the U.S. are among the top domestic issues cited by voters in national polls ahead of the November presidential election.

Members of the trade group are among those that helped derail the last major effort at national health reform, spearheaded by then-first lady Hillary Clinton.

During that period, "we were reacting" to proposals, AHIP President Karen Ignagni said.

The changes would include giving doctors, patients and payers access to research comparing treatments to guide clinical decision making. Such research is rare now because manufacturers have little financial incentive to do it.

Lawmakers are currently debating setting up an independent body to do the research. The idea has some drug and medical device makers worried that the body would be used to blindly deny treatment.

The AHIP plan also would include aligning patient outcomes and safety with reimbursement, an idea cited in many other reform proposals. In general such pay-for-performance proposals pay doctors more when they meet certain clinical standards.

The current payment system largely pays for care on a fee-for-each-service basis, regardless of outcome.

The plan also advocates a focus on so-called disease management, aimed at preventing and controlling chronic disease. Management is generally cheaper than emergency care.

"I think the important lesson is - they get a range of savings that is reasonable. It suggests there is a growing consensus that these elements are what are needed for change to happen," said Len Nichols, a healthcare economist at the New America Foundation, a nonpartisan research group.

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