The COVID-19 pandemic has shattered public faith in the old quality agenda and has left people wondering what is a credible, effective, affordable, sustainable alternative. Buyers, policy makers and care providers are looking for a new course of action. The timing is right for reforms that deliver demonstrable, measurable benefits and avoid dysfunctional effects.
The first principle is a recognition that the system needs to deliver value. This means achieving lower prices and demand through a combination of innovative financing strategies. It also means avoiding perverse incentives that drive excessive, unnecessary, and ineffective use of resources. It requires a more unified information system that supports clinical care, performance improvement, choice, and accountability. It should also reduce complexity, confusion, and both administrative and clinical waste and provide a foundation for resilience and responsiveness to future health threats.
Another critical principle is to focus payments on beneficiary populations’ actual medical needs, rather than on their historical spending patterns which may be distorted by inequities that payment policy should not perpetuate. This includes addressing the imbalance between physician compensation and cost of living, improving workforce policies, enabling the integration of mental health and substance use services into primary care settings, and increasing support for community-based organizations that serve underserved populations.
Finally, the need to support the existing safety net for residually uninsured populations must be preserved. This will require a shift from funding high-cost insurance premiums to supporting American patients by giving them direct control over their health subsidy, and encouraging them to shop for the best value care available. It also requires a rebalancing of the primary care supply, and supporting the training of physicians to work in underserved communities and for low-income patients.