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Payment Reform a Must in New York, Health Care Expert Says

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As the Affordable Care Act makes sweeping changes to the health care industry on a federal level, it is more important than ever for New York to enact its own reforms, according to a state industry expert.

Left to right, Dr. Alvin I. Mushlin, chairman of the Department of Public Health; Donna Lubin Golden, sister of Dr. Madelon Finkel; Dr. Madelon L. Finkel; Dr. James R. Knickman; and Dr. Oliver T. Fein, associate dean of affiliations
Credit: Patricia Kuharic

New York's health care costs are higher than ever, but the expense isn't always reflected in the quality of patient care, said Dr. James R. Knickman, president and CEO of the New York State Health Foundation. It's clear, he said in a Weill Cornell Medical College lecture last month, that payment reform is vital to ensure health care dollars are spent keeping patients healthy rather than perpetuating a system that reimburses quantity of procedures over quality of care.

The question is: Can the various stakeholders muster up the political action to enact reform?

"New York has a history and culture of reform and leadership on health care issues," said Dr. Knickman, who was honored as the 12th annual Lorraine and Ralph Lubin Distinguished Visiting Professor in Public Health. "But it is less clear if there are shared goals among stakeholders. There has not yet been any legislation passed in New York State to reform health care payment in the private insurance realm, and no collaborative efforts to accomplish such legislation."

Like many states, New York's health care system is reliant upon fees for service, which pay for volume of care and procedures rather than health outcomes. It's a system widely blamed, at least in part, for the skyrocketing cost of health care.

Recognizing the unsustainable nature of this system, a handful of states — Massachusetts, Vermont, Maryland, Oregon, Arkansas and California among them — have implemented new laws and programs that encourage health systems to coordinate care. Some have enacted bundled payments. Others offer bonus payments for meeting quality measures, a practice known as pay-for-performance. These and other alternatives to pay-for-performance are promoted by the ACA.

But so far in New York, there has been limited energy for health care reform apart from some initiatives that have been enacted in the Medicare and Medicaid systems. Dr. Knickman attributes this to the fractured nature of New York's health care system: dozens of insurers with regional dominance, numerous hospitals and care providers, other industry organizations and policymakers — all of whom play by different rulebooks and whose goals may not be shared.

That's something the health foundation, whose mission is to improve the wellbeing of all New Yorkers, is dedicated to change. The foundation has set a goal of 2017 for the state to craft a statewide or regional proposal for mandatory alternative payment arrangements.

In order to get all of the stakeholders at the same table, researchers will need to conduct evidence-based studies that more effectively use data to make a compelling case for payment reform, Dr. Knickman said. These studies would compare the cost of care across the state for different populations as well as compare providers — data that will require better integration of electronic medical records as well as information from Medicare, Medicaid, and private insurance companies.

"All of these facets would require leadership from the government, hospital systems and other stakeholders to make reform efforts a priority," he said.

The Lorraine and Ralph Lubin Distinguished Visiting Professorship in Public Health was established with a gift in memory of her parents from Dr. Madelon Lubin Finkel, professor of clinical public health and director of the Office of Global Health Education at Weill Cornell. The Lubins strongly believed in the value of education as a means to making a difference in the lives of others. Each recipient of the annual award has achieved the highest recognition in either the field of epidemiology or health care policy and is regarded as an excellent role model for students. In addition to presenting the keynote address at the Rogers Colloquium, the visiting professor meets during the day with medical students, faculty and members of the administration.

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