Special Feature

Medicare reform must focus on quality to improve outcomes, reduce costs, experts say

Health care experts agree that today's Medicare system is unsustainable. But what would Medicare reform look like, and what needs to happen to put the nation on the road to reform?

National thought leaders—including Thomas Claffey, MD; Grace Terrell, MD; and Edward G. Murphy, MD (pictured above)—discussed these issues Tuesday at a National Journal policy forum underwritten by the AMA. Consisting of three panel discussions, the event brought together physicians, health care executives, congressional staff experts and other key voices to explore ways to build a higher-performing Medicare system.

Panelists said the Medicare system needs to focus on quality of care rather than the volume of services provided—a fundamental change that will require restructuring how care is delivered and paid for.

"Not enough attention has been paid to improving quality and efficiency," said Gail Wilensky, senior fellow at Project HOPE and former director of the Medicare and Medicaid programs. "We need to find the best way to help physicians so they can take care of their patients."

Dr. Murphy, professor of medicine at Virginia Tech Carilion School of Medicine, noted that chronic diseases have become the primary health issue for most American patients. But today's system doesn't support the kind of continuous care needed for disease management.

Panelists suggested that improving outcomes and reducing costs in the Medicare system will require more team-based care and greater collaboration among physicians. One recommendation was that physicians could more efficiently interact with Medicare collectively through physician organizations, including multispecialty medical groups, independent physician associations, hospitals or accountable care organizations.

Models for delivery and payment reform will need to be developed and tested, panelists said.

Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University, pointed to new models that have worked for communities around the United States. He believes Medicare would do well to join successful local initiatives and then adapt those models for wider use.

"We don't need the whole country to do it on their own," Nichols said. "We do need good examples to show everyone else how it works."

Panelists also noted the importance of physician leadership in developing and implementing such changes. Another key to success will be collaboration across stakeholders, including Medicare, private payers, patients and employers.

In closing remarks, AMA Executive Vice President and CEO James L. Madara, MD (left), underscored the need for reforming Medicare. He pointed to the AMA's driving principles and core elements for transitioning to a high-performing Medicare system, which the AMA and more than 100 other medical associations have submitted to Congress.

Dr. Madara said the AMA is collaborating with numerous stakeholders to make the entire health care system a high-performing one for physicians, patients and the nation.

"We're focused on value and quality care," Dr. Madara said. "And we're focused on educating physicians in a way that would allow them to participate in this future that's more team-based and quite different than medicine of the past.

"We're also thinking about physician sustainability of practice so physicians can do what they love to do—and that is taking care of patients."

Tuesday's forum supports the AMA's work in shaping delivery and payment models to enhance professional satisfaction and practice sustainability, one of its three strategic focus areas.