Local, National Reforms Both Needed, Policy Leaders Told

BALTIMORE — Although their approaches may appear to be at odds with each other at the onset, a top federal bureaucrat and a national business leader assured health policy leaders Wednesday that government and commercial interests can work together effectively to reform the country’s health care system.

“We’ll figure it out together. We may not figure it out as quickly as people might like, but we will get there,” said Richard Gilfillan, director of the Center for Medicare and Medicaid Innovation.

Gilfillan and Andrew Webber, president and CEO of the National Business Coalition on Health, shared the podium to deliver a tandem farewell address at the National Academy for State Health Policy’s 25th annual conference.

“I represent the purchasers of health care, and I’m glad the finger is being pointed back at us as the engine of change,” Webber said. “We have to figure out how we as payers get out of our silos. How do we get to value-based purchasing strategies? How do we reward high performance?”

Webber said most of the answers can be found close to home.

“We believe all health care is local,” Webber said. “That’s where the attention needs to be concentrated. In the words of Pogo, ‘We have met the enemy and he is us.’ Is there any surprise that our fee-for service system is expensive and fragmented? We need to change that and we think the best place to start is in your own communities,” Webber said.

Alan Weil, NASHP executive director, pointed out that the two visions represented at the podium — Webber’s ground-up approach and the Center for Medicare and Medicaid Innovation charged with finding new ways to deliver and pay for nationally subsidized health coverage — appear to be at opposite ends of the spectrum.

Gilfillan said that although he and other officials at CMS look at issues with a national perspective, they recognize that one size and shape doesn’t always fit all places and situations.

“We recognize there will be differences in various markets,” Gilfillan said. “We recognize that what works in Western Pennsylvania or Idaho or Maryland or Vermont may not work everywhere. But over time, we’ll see an evolution of things that do work. How much is going to be local and how much national I don’t know, but we need to get on the ground and give you support for things you think can work in your state,” Gilfillan said.

Almost 700 policy leaders, administrators and experts from all 50 states convened for NASHP’s three-day conference. It was the largest conference in the organization’s 25 years of existence. California, as usual, had one of the largest contingents with more than 40 attendees.