“The twenty-two-member council is a nonpartisan, multidisciplinary expert working group under the leadership of cochairs William Frist [former US Senate majority leader] and Margaret Hamburg [former commissioner of the Food and Drug Administration]. This report contains the council’s recommendations. [..]
The goal of the recommendations in this report is to achieve higher-value health care spending and growth in the US. The mechanism for achieving this goal involves four levers:
- price, or paying the most efficient price for care;
- volume, or ensuring the appropriate quantity of care;
- mix, or ensuring the appropriate types of services for patients and populations; and
- growth, or growing the price and volume sustainably and maintaining an appropriate mix over time. [..]
The council examined literature and received input from experts in its inquiry into drivers of spending and growth that met the following criteria: a meaningful amount of money is potentially at stake, it is likely feasible to address the spending driver through policy intervention, and the council, drawing on the unique expertise and perspectives of its members, can make a powerful contribution to the debate.
On the basis of these criteria, the council offers recommendations in four priority areas:
- administrative streamlining,
- price regulation and supports for competition,
- spending growth targets, and
- value-based payment.”
Extracted from the Executive Summary’s Exhibit ES-2 and other parts of the Executive Summary:
Administrative streamlining
- Standardization of four key “between” and “seismic” processes
- Collection of data for provider directories
- Collection of data to support credentialing of providers
- Claims processing
- Collection of data to support prior authorization
- Longer-run harmonization of quality measures
Price regulation and supports for competition
- Increased state and federal monitoring of market competitiveness and scrutiny of proposed mergers
- Limited price regulation in markets that cannot be competitive
- Performance improvement plans and conditional price regulation in markets that could potentially be competitive
- Additional supports for competition in markets that are currently competitive
Spending growth targets
- Data-supported spending growth target setting
- Data-supported monitoring of spending growth
- Data-supported enforcement of spending growth targets
- Federal support for data infrastructure
Value-based payment: continued evolution of value-based payment models
Executive Summary and Full Report, Health Affairs Council on Health Care Spending & Value, February 2023