Making Medicare Sustainable

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Rising health care costs place increasing strain on state and local budgets and threaten the long-term stability of the Medicare program. In order to begin to control health care costs nationwide and make the Medicare program more sustainable, Medicare must become a more value-based purchaser of health care.

Medicare experts from across the country joined the New America Foundation on July 23rd in Washington, DC, to propose innovative ways to reform our Medicare program.

Dr. Lawrence Casalino from the University of Chicago kicked off the day-long conference by presenting his paper about value-based purchasing opportunities in traditional Medicare. Casalino discussed the merits of medical homes, accountable care systems (ACSs), pay for performance, and public reporting. (PowerPoint Presentation)

The next presenter, Timothy Jost of the Washington and Lee School of Law, addressed the legal and regulatory issues surrounding Casalino’s proposed solutions. He explained that in some cases accommodating value-based purchasing will require changes in HHS regulations. In other instances, he explained, the impediments to value purchasing are statutory, and Congress will have to act to remove them. (PowerPoint Presentation)

Dr. Charles Boult from the Johns Hopkins Bloomberg School of Public Health, examined what policies and processes work best for Medicare beneficiaries that are particularly vulnerable. He suggested that lawmakers consider interdisciplinary and supplemental primary care, transitional care between hospital and post-acute settings, and advance practice nurse-physician partnerships for caring for Medicare’s sickest enrollees. (PowerPoint Presentation)

To round out the morning session, New America’s Len Nichols, PhD, and Dr. Bob Berenson from the Urban Institute proposed a board-like entity to oversee the Medicare program and relieve some of the political pressure from lawmakers in Congress. (PowerPoint Presentation)

After listening to luncheon keynote speakers, Congressman Ron Kind (D-WI) and former Congresswoman Nancy Johnson (R-CT), attendees heard from two panels about the possibilities for Medicare reform. Panelists agreed that many of the general concepts presented at the event will play some roll in reforming the Medicare program. However, they reminded us that many of these reforms might require Congress to cede some of its decision-making power to other sources. Therefore, in order to implement these reforms, it will be important to allow Congress to relinquish some of its day to day decision-making while maintaining legislative ownership of the Medicare program.

For more information visit the New Health Dialogue blog.

**All papers presented at the conference were in DRAFT form. Final versions will be compiled and released in the fall.**

To watch a video of the event and for transcripts, please visit the Kaiser Family Foundation website.

Agenda

8:15 a.m. Registration & Continental Breakfast

8:45 a.m. Welcoming Remarks - Medicare Financing and Health Care Cost Growth
Len Nichols
Director, Health Policy Program
New America Foundation

9:15 a.m. - Value-Based Purchasing in Medicare
Lawrence Casalino, MD
Associate Professor
University of Chicago
Mark Miller
Executive Director
Medicare Payment Advisory Commission

10:00 a.m. - Value-Based Purchasing: Laws and Regulations
Timothy Jost
Robert Willett Family Professor
Washington and Lee University School of Law
Lynn Etheredge
Consultant, Rapid Learning Project
The George Washington University

10:45 a.m. - Break

11:00 a.m. - Protecting Medically Vulnerable Older Americans
Charles Boult, MD
Professor and Director, Lipitz Center for Integrated Health Care
Johns Hopkins Bloomberg School of Public Health
Randall S. Brown
Vice President; Director, NJ Health Research, Research Division
Mathematica Policy Research, Inc.

11:45 a.m. - Synthesis: Roadmap for Medicare Reform
Len Nichols
Director, Health Policy Program
New America Foundation
Robert Berenson, MD
Senior Fellow
The Urban Institute
Joseph Antos
Wilson H. Taylor Scholar in Health Care and Retirement Policy
American Enterprise Institute

12:30 p.m. - Break and Lunch

12:45 p.m. - Luncheon Keynotes
The Hon. Ron Kind (D-WI)
United States House of Representatives
The Hon. Nancy Johnson
Senior Public Policy Advisor
Baker Donelson
Robert Berenson, MD (Introductions)
Senior Fellow
The Urban Institute

2:00 p.m. - Break

2:15 p.m. - Panel I - Can Medicare Become a Value-Based Purchaser?
John Bertko
Adjunct Staff
RAND
John Rother
Policy Director
AARP
Billy Wynne
Health Counsel
Senate Finance Committee
Robert Berenson, MD (Moderator)
Senior Fellow
The Urban Institute

3:15 p.m. - Panel II - A New Medicare Governance
Thomas Stanton
Fellow, Center for the Study of American Government
Johns Hopkins University
Mark Peterson
Professor of Public Policy and Political Science
University of California, Los Angeles
Elizabeth Fowler
Chief Health Policy Advisor
Senate Finance Committee
Susan Dentzer (Moderator)
Editor-in-Chief
Health Affairs

4:15 p.m. - Closing Remarks

Related Links

• Len Nichols' PowerPoint Presentation (PDF, 15 pps.)
• Lynn Etheredge's PowerPoint Presentation (PDF, 6 pps.)