Hillary Clinton Announces Agenda to Improve the Quality of Health Care for All Americans
As President, Hillary would fundamentally reform the nation’s health care system by lowering costs, improving quality, and covering all Americans. Earlier in the campaign, she announced a multi-faceted plan to lower costs and increase value in the nation’s health care system, which taken together would lower national health spending by at least $120 billion a year. Today, she announced several proposals that build on those initiatives to ensure high quality care by empowering health professionals, patients, and private and public payers to improve the financing and delivery of health care that every American receives. And next month, she will unveil her proposals to ensure universal coverage, so that every American will have quality, affordable health care.
Hillary’s agenda returns patients to the center of the health care system again by empowering and relying on the skill of those who provide care – physicians, nurses, other clinicians, and health care organizations – to improve that care continually.
Hillary’s Agenda: Reforming Health Care by Focusing on Quality
A reformed high-quality healthcare system must include a strong evidence base so we know what treatments work best, a quality measurement infrastructure based on this evidence to assess the quality of care patients receive from their health care providers, the integration of those quality measures into the delivery of care through health information technology, reimbursement incentives and accountability, and a commitment to placing patients at the center of the system, through increased transparency and greater access to information. To achieve this, Hillary will:
Empowering Providers:
1. Empower Physicians to Improve Quality Through Physician-Driven Certification Programs: In our health care system today, there is tremendous variation in the cost and quality of care from state to state, and even from hospital to hospital in the same town. For example, in Wilkes-Barre, Pennsylvania spine surgery rates are 1.99 per 1,000 Medicare patients, while in Lancaster, they are 5.44 per 1,000. Physician specialty boards, such as the American Board of Internal Medicine, have established Maintenance of Certificate (MOC) programs to promote lifelong learning and help doctors stay up to date on the latest scientific advances and procedures. Doctors who scored higher on MOC examinations had better outcomes in treating patients with diabetes, and were more likely to ensure that their patients received mammograms. Heart attack patients treated by board certified doctors were 15% less likely to die than those treated by non-certified doctors. MOC programs help ensure that the right care is given to patients at the right time, improving quality, while reducing costs. Hillary’s proposal would federally recognize these initiatives and create financial incentives for participating in them.
2. Recognize Independent Private-Public Quality Trust and Improve Quality Measures: As President, Hillary would direct the Secretary of HHS to invest $125 million in federal funding to recognize a private-public consensus-based organization, such as the National Quality Forum, to (a) certify for enhanced reimbursement physician, hospital, and nursing home MOC programs, (b) identify gaps in existing national quality measures, (c) set national priorities for the development and testing of new quality measures, (d) fund organizations with expertise to develop additional measures that advance national priorities, and (e) endorse quality measures for use in MOC programs and more broadly by physicians, hospitals, nursing homes, and other healthcare providers. And through the Best Practices Institute announced by Hillary earlier this year, disseminate the highest quality, most effective protocols and treatments to ensure they are used everywhere. This proposal will help hold healthcare providers to the highest standards and ensure they have the best information to inform their work with patients.
3. Emphasize Quality in Health Care Workforce, with Focus on Nurses: Provide federal funding to address nursing and nurse faculty shortages and nurse retention issues by establishing innovative training and mentoring programs. A severe nursing and nurse faculty shortage has led to understaffing and nurse-to-patient ratios that jeopardize patient safety in hospitals and limit the availability of care outside of hospitals. America is not training enough nurses to meet our needs yet nursing schools turned away more than 32,000 qualified applicants in 2005. And we are not retaining those who do join the profession; currently 50 percent of new nurses leave their jobs within the first year.
Empowering Patients:
4. Empower Patients with Information on Provider Performance: Informed consumers make decisions that promote the right kind of competition and higher quality and reflect their underlying values and preferences. However, very limited information is available to help patients understand how to choose the best providers, what treatment options are available, what works, and how to stay healthy. Hillary would expand and improve information available to patients by making data and decision-making tools that give consumers information about their local providers readily available and understandable. Patient-centered care should be designed to improve patient decision making as well as the quality of their health care; it should not shift health care costs onto patients. At the Dartmouth Hitchcock Medical Center, the Center for Shared Decision Making helps breast cancer patients understand their options and make informed decisions about their treatment. The program gets high marks from patients - 98 percent reporting that they understood their treatment choices and 96 percent reporting they understood which treatment risks and benefits mattered most to them as they made their decision.
5. Reduce Health Care Disparities: Racial and ethnic disparities are pervasive throughout our entire health care system. In 2003, the Agency for Healthcare Research and Quality (AHRQ) found “that racial, ethnic and socioeconomic disparities are national problems that affect health care at all points in the process, at all sites of care, and for all medical conditions – in fact, disparities are pervasive in our health care system.” Minorities are more likely to be diagnosed with late-stage breast cancer and colorectal cancer compared to whites, and Hispanics hospitalized for acute myocardial infarction are less likely to receive optimal care. Infant mortality rates among African American populations are more than twice as high as those for whites. According to the annual National Healthcare Disparities Report, released by the AHRQ, blacks and Hispanics received poorer quality care than whites on more than 70 percent of the measures.
Empowering Purchasers and Payers:
6. Incentivize Quality Through Increased Federal Payments: Hillary proposes providing higher payments to healthcare providers that use coordinated care delivered by teams of health professionals to treat the whole patient instead of the patients’ individual illnesses. Most federal payments to health care providers do not differentially reward high quality providers. Our current system of reimbursement creates barriers to collaboration among organizations and among health care professionals, leading to fragmentation in the health care system. Doing what’s best for patients shouldn’t be bad for business.
7. Prohibit Payment of “Never Events” in FEHBP and all Federal Programs: The Bush Administration’s recent decision to refuse Medicare payments for preventable infections, injuries and errors--so-called “never events”--sustained during hospital stays is a positive step. Hillary will insist that any insurance company wishing to provide coverage through the Federal Employee Healthcare Benefits Program also refuses to cover these costs. This proposal will incentivize good care with smart reimbursement policies
These proposals to improve quality build on Hillary’s existing health care agenda:
Institute a New “Paperless” Health Information Technology System: Modernizing our health care system through the use of information technology will empower doctors and other healthcare providers to communicate electronically and will reduce waste and redundancy while improving safety and quality by reducing medical errors. Overall, the RAND Corporation estimates net savings to be $77 billion per year. An up-front and phased-out $3 billion a year investment fund would be provided to help hospitals and doctor’s offices adopt and implement HIT. The proposal will give doctors financial incentives to adopt health IT and facilitate adoption of a system where high quality care and better patient outcomes can be rewarded.
Transform Care of Today’s Chronically Ill Population to Improve Outcomes: The largest driver of health care costs in the nation is related to the small numbers of Americans who have multiple chronic diseases. These diseases, such as cardiovascular disease and diabetes, account for 75 percent of our total national health expenditures and are the leading causes of death in the U.S. A recent RAND study projected nearly $30 billion in national health expenditure savings per year after implementing disease and lifestyle management programs. Combined with prevention and health information technology, with full participation, the U.S. health system could save $147 billion alone for better care of this vulnerable population. Senator Clinton will ensure higher quality and better coordination of care by using state-of-the-art chronic care coordination models within federally-funded programs to provide care for Americans afflicted with these costly, multi-faceted illnesses. She’ll provide incentives to participate in these chronic care management programs.
Create an Independent “Best Practices” Institute and Invest in Research for New Treatments: Patients, providers, and payers would benefit from getting better information on what works in health care and how treatments compare to one another. Researchers at Dartmouth have found that more care is not better care, and that inefficient care may do more harm than good. Therefore she will create a new Best Practices Institute, which would be funded by both the private and public sectors, since its results will benefit all payers. Research will compare the effectiveness of alternative treatments such as pharmaceuticals, devices, and surgeries. For example, information supplied by organizations such as the Drug Effectiveness Review Project (DERP) has been used in North Carolina to educate providers and improve quality of care, saving the state an estimated $80 million in 2003. This research will facilitate the development of quality and outcomes measures for use by hospitals, physicians, nursing homes, and other healthcare providers.
