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Friday, Michael Miller of Massachusetts-based Community Catalyst presented to the Cost, Cost Containment & Finance Working Group of the HealthFirst Authority. His presentation focused on “cost containment strategies in other states.”

He opened with, “Cost containment is not a useful framework.” He went on to say that if we were spending more than other countries and were getting better care, that would be a good trade off, right. But, though it is true that we are paying more, we are actually getting worse care, by many measures. The frame, then, should be, “Are we getting our money’s worth?” or “How do we get our money’s worth?”

Miller described the current state of the US healthcare system: health purchasing in the US is less coordinated than in the rest of the industrial world; we devote more of our healthcare dollars to high-tech and specialized care; our healthcare resources are distributed unequally; and our administrative costs are very high.

He offered numerous possible solutions, with the caveat that they must be done well.
Pay for Performance, should be Pay for Improvement
Regulation of healthcare at the level of insurers, capital expenditure and (less so) providers
Improving care coordination for the chronically ill
Increasing administrative efficiency
Addressing the primary care crisis
Enacting medical technology review at the federal level (or through interstate cooperation)
Value-Based Benefit Design
Smarter prescription drug purchasing
Public health initiatives to reduce the occurrence of certain conditions

In the coming year, Community Catalyst will be studying each of these areas to see what it takes to make these suggestions successful – in terms of both policy and politics. I, for one, am looking forward to their reports.
Connie Razza