NBCH Policy Papers

Statement of Principles for Health Care Reform

The quality of health care can be improved for consumers while still controlling the cost, but only if purchasers seek the best value -- and not just the lowest price.

Improved measurement systems are enabling smart buyers to compare the performance of providers in delivering the best quality at the most reasonable cost.

Coalitions already are working in partnership with providers to develop such measures in many communities, and use them to improve the quality and reduce the cost of health care delivery.

NBCH supports reform that puts the emphasis on value instead of price by requiring physicians and health plans to report measures of their performance -- their results compared with their costs. Focusing on value-based purchasing protects consumers by rewarding quality health care.

NBCH encourages government to join private employers in purchasing health care based on value, for public employees and for beneficiaries of Medicare and Medicaid.

CONSUMER EDUCATION AND RESPONSIBILITY

A properly working health care market also requires patients to assume responsibility for making good decisions about their health care and their health. Americans need comparative information on quality, cost and service to make those decisions.

NBCH supports reform that gives consumers this information, shows them how to use it, and offers them incentives for healthy behavior.

NBCH also supports the continued strong role of employers as advocates for their employees in seeking value from providers in the complex environment of the health care marketplace.

CONTROLLING COSTS BY IMPROVING THE DELIVERY SYSTEM

Health care costs can be reduced and the quality of services improved at the same time through re-structuring health care delivery to make it more efficient and more effective.

By rewarding health plans and provider systems through financial incentives, coalitions are slowing cost increases dramatically and holding health plans/provider systems accountable for efficiently delivering quality health care.

NBCH supports reforms that make greater use of natural market forces guided by improved information and delivery system integration to control costs.

COORDINATED CARE AND ACCOUNTABLE DELIVERY SYSTEMS

Appropriate delivery of medical services by coordinated provider systems is demonstrating the ability to slow rising costs in may parts of the nation, while enhancing both the quality of care and consumer satisfaction.

NBCH encourages development of more coordinated delivery of care by providers that seek greater efficiency, strive to improve quality, and emphasize preventive services and health promotion as well.

In some marketplaces, a lack of competing systems of care may prevent purchasers form holding providers accountable through the normal market forces of competition; in these communities, accountability must be established through such mechanisms as benchmarking the performance of providers against other communities.

INSURANCE MARKET REFORMS

Availability of affordable health insurance to all Americans requires special attention to the needs of small businesses that account for a majority of the uninsured and of individuals who are changing jobs.

NBCH supports federal preemption of state mandated benefits that make affordable basic coverage unavailable to many.

NBCH also supports changes in insurance underwriting practices to promote portability of coverage for individuals.

Employers must continue to have the flexibility to design and manage their health benefits, which is assured them by ERISA.

NBCH opposes all attempts to mandate insurance coverage or the specific provisions of employee health benefit plans.

MALPRACTICE REFORM AND PROVIDER ACCOUNTABILITY

Employers oppose legislation, regulation, rules, contract language or doctrine that increases litigation costs or liability or would create adversarial relationships between patients, providers, purchasers and payors of health care. Employers expect that physicians will be accountable for the patient and will take responsibility for their own actions.

NBCH supports significant reforms in medical malpractice to reduce the cost of defensive medicine practiced to avoid the threat of lawsuits.

Physicians should be held accountable for their performance, through appropriate measures of medical outcomes as well as conformance with medical practice guidelines.

MEDICARE AND MEDICAID

Medicare and Medicaid must embrace the principles and approaches of value-based purchasing being established by and for private purchasers.

Standards of value and accountability are necessary to eliminate cost shifting from Medicare and Medicaid to private purchasers while bringing spending for these programs under control. NBCH opposes efforts to control spending on these programs, however, by shifting further costs to the private sector.

ANTITRUST AND COMPETITION

NBCH supports maintenance and active enforcement of the antitrust laws to prevent anti-competitive behavior by providers and would generally be opposed to relaxation of existing antitrust laws, unless the effect is to specifically and affirmatively promote competition.

Aggressive and effective antitrust enforcement in health care is encouraged in all markets, whether with multiple, competing providers and care systems, or smaller markets with only one or two competitors. Effective enforcement is an important role of government, the goal being to maintain competition that is vital to the success of private sector market-based reform.

NBCH is working with the Federal Trade Commission and the Justice Department to end anti-competitive behavior.

MEDICAL SAVINGS ACCOUNTS

NBCH believes MSA proposals should increase portability and employee responsibility in the provision of health care benefits. Any MSA legislation should allow, but not require, employers to offer MSAs; be consistent with the growth of managed care and group purchasing power; not result in increased tax costs to employers; not encourage adverse selection among plans; and permit employers to continue to design and price their health care benefits. They should not discourage necessary care and should encourage capitation and alternatives to fee-for-service delivery of care.