"As the nation turns to the issue of reforming our health insurance system, it is important to address simultaneously how we organize and deliver health services—to ensure that we are obtaining the best possible health outcomes for Americans and the most value for the money we spend on health care," Commonwealth Fund president Karen Davis told the U.S. Senate Committee on Health, Education, Labor, and Pensions at a hearing held on Jan. 29.
In her invited testimony at the hearing, "Closing the Quality Chasm," Davis said that "the nation will not have the health system it wants if the federal government does not lead and implement a series of coordinated strategies to close the quality chasm," including:
- extending health insurance to all;
- aligning financial incentives to reward the outcomes we want to achieve;
- changing the organization and delivery of care to ensure that it is accessible, coordinated, and patient-centered;
- investing in the infrastructure and support necessary to reach attainable levels of quality and efficiency; and
- exercising the leadership and collaboration among all parts of the health system necessary to achieve health goals for the nation.
Davis called attention to models of high performance in health care delivery that already exist in states and regions across the U.S. and in Europe.
At a Senate hearing on Feb. 24, Cathy Schoen, a Commonwealth Fund senior vice president and noted expert on the underinsured, made the case for redesigning health insurance so that it "provides affordable coverage for all in a manner that ensures access to health care and financial protection" as well as "a more secure foundation for payment and system reforms."
Schoen says that our "fractured insurance makes it difficult to develop coherent payment policies that could align incentives with better outcomes and prudent use of resources." She outlined a number of insurance reforms for the committee, among them:
- setting a minimum floor and standard for health insurance, with benefits designed to support access to effective care and protection when sick or injured
- providing income-related premiums to ensure coverage is affordable
- establishing lower cost-sharing and ceilings on out-of-pocket expenses for low-income families
- limiting the range of variation to facilitate choice and discourage risk segmentation
- ensuring insurance access and renewal and prohibiting premium variations based on health risks
- structuring insurance choices through a national insurance exchange to help individuals and families choose coverage and stay continually insured.