Physician and Penn Vice-Provost Ezekiel Emanuel Advises Candidates: The First Priority, For A Majority of Voters, is The Cost of Healthcare

Last Friday morning, Zeke Emanuel, physician and vice provost at the University of Pennsylvania, authored an op-ed in the New York Times about the real issue in USA health care: the cost. He proposes four specific actions to start driving down the cost of care – and by doing so making it more available and affordable for everyone:

  1. Bring down drug prices through national and Medicare negotiation with pharma toward value-based drug pricing
  2. Cap hospital inpatient pricing to a Medicare-pegged ceiling
  3. Reduce wasteful insurance billing practices
  4. Speed up the transition from Fee-for-Service to Value-based Payment Models – in other words, accelerate Population Health

First Things First: Primary focus should not be “Medicare for All”, but rather “Value-based Care for All”, or “Lower-Cost Care for All” – at all levels (drugs, hospital care, overall care).

Specifically, Dr. Emanuel recommends that at least 50% of payments by insurance companies have a value-based component within three years. That’s not enough. Today, 85% of Medicare Payments have a value-based component – and that value-based component itself happens to be rather small. The requirement should increase the percent of at-risk or value-based revenue, which is still small. (The Health Care Payment and Learning Action Network most recent estimate has 41% of revenue in full Fee-for-Service, 25% with a “light” link to value, and 34% with a strong link to value – and that’s the number that needs to go up faster).

Take-away: Dr. Emanuel is right, we need specific proposals to bring down cost of care in the US – and one of the ways to get there is faster transition to Value-Based Care. Let’s hope that our next administration will take up this challenge. It would be good for patients and families. And in many ways it would be good for healthcare organizations also, by placing the incentive on high-quality, low-cost, population-focused care.

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