Over the past several months, America's Agenda President Doug Dority and I have crisscrossed the country, meeting with union and employer leaders from coast to coast, having the privilege of addressing forums from the National Coordinating Committee for Multi-Employer Plans (NCCMP) in Washington, D.C. to the Food and Drug Council in Sacramento, CA.
We believe our message is urgent and important to the survival of America's employment-based health insurance system - at least, until a better solution is ready to replace it: In the aftermath of federal health reform, employment-based health plans can reign in hyperinflation in plan costs, while improving quality care to workers and their families, only by transforming the way health care, itself, is delivered to their members. The old techniques of tinkering with insurance benefit design, increasing cost-sharing borne by employees and their families, and layering remote disease management services over a volume-driving, fee-for-service insurance system are simply too weak to reign in the unsustainable rates of growth in the costs of our health plans.
An abundance of evidence has accumulated over recent years that demonstrates the stunning levels of savings and the rapid returns on investment that result when fragmented, fee-for-service care delivery (the current standard) is replaced by team-based models of patient-centered health care emphasizing expanded access to primary care providers, high quality care delivered by physician-directed personal health teams, and focus on evidence-based best care (as distinct from most care) for patients. . Before enactment of the federal Affordable Care Act, the best-designed disease management vendor programs commonly added to a fee-for-service insurance plan boasted reductions in cost growth by up to 1.5%. Savings of that amount aren’t insignificant, of course, but the evidence shows we can do much better.
Reengineered team care delivery models across the country – models that integrate comprehensive chronic disease prevention and management directly into the primary care medical practice -- are delivering cumulative annual savings of far greater magnitudes, ranging from 5% to mire than 11% per year. Recent projections show that the statewide team care delivery reform America’s Agenda won in Vermont will lower statewide costs by 28% over five years. (Check out slides and videos about team care delivery here.)
Over the year since federal insurance reform was enacted, America’s Agenda has focused intensively on providing the guidance, tools, and direct assistance needed to enable jointly-governed Taft-Hartley funds and other employment-based health plans to reengineer care delivery to their members and achieve comparable results. Along the way, we’ve discovered unprecedented enthusiasm among visionary union leaders and employer partners for taking on the challenge. America’s Agenda has brought together Taft-Hartley trustees and innovative health care providers in the East, Midwest, and on the West Coast to design and launch game-changing transformation of health care delivery for their members.
The vision these bold and innovative union and employer leaders share for transforming health care delivery in the funds they govern is the greatest hope our country has for containing growth of costs, while improving quality care for all Americans. The new care delivery systems these leaders create for their members will be the foundation for transforming delivery of health care to their entire communities. This is the cutting edge of the kind of health care transformation working American families want.