It's no longer if health reform will happen, or even when, but how. The Obama administration has made it a clear top priority.

While healthcare leaders have been proposing a variety of solutions for years, some of the top national organizations have joined together to consolidate opinions and now have delivered a collaborative recommendation through their Health Reform Dialogue.

"This is not a wish list. It's a blueprint for getting to a system that provides universal care," David Nexon, senior executive VP for the Advanced Medical Technology Association (AdvaMed; Washington), told Medical Device Daily. "It's a proposal that's complementary and supportive of where the president would like for us to go."

He pointed out that this group, unlike the plethora of others commenting on healthcare reform, is comprised of leaders from 18 different organizations and that they began exchanging views on policy issues six months ago to create a forum outside of the political arena.

"There's enough specificity in this report to get beyond the cliché level," said Nexon, who was previously Democratic Health Policy Staff Director for the U.S Senate's Health, Education, Labor, and Pensions Committee and senior health policy advisor to Sen. Edward Kennedy (D-Massachusetts).

"For decades, attempts to reform America's health system have met with fractious debate," said Georges Benjamin, MD, executive director, American Public Health Association (Washington). "Until now, comprehensive healthcare reform has been deadlocked. The time has come to set aside some of our differences, talk openly with each other, and begin to find common ground. This process has significantly helped steer us toward that outcome."

The Health Reform Dialogue's blueprint for healthcare reform, Nexon said, would likely impact the way the med-tech sector does business.

"It's going to vary, product by product, but it will have a positive impact," he said. "The emphasis is going to be on value and comparative effectiveness. Products would receive more scrutiny and some things that may have been moneymakers in the past may not continue to be so."

He declined to give a product example, but said the bottom-line results would be positive for most companies and consumers.

"Everyone here has made a concession in order for health reform to move forward. The president and Congress should approach health reform in the same spirit of commitment and compromise," said Stephen Ubl, president/CEO of AdvaMed. "Disease knows no ideology, nor boundaries. As DC delays, people die. America deserves action now, not excuses."

The group has identified consensus in several key areas. These include:

All reforms should be aimed at having all Americans purchase or otherwise obtain health insurance.

Advanceable, refundable tax credits or other subsidies should be made available to help more people afford health coverage.

Federal funding should be provided to help states with rising Medicaid costs and to establish a baseline for Medicaid eligibility for all adults at no less than 100% of the federal poverty level.

There should be a public-private partnership to research ways to compare clinical effectiveness of treatments.

Medicare payment reforms should increase value by improving prevention and care coordination.

Funding should be provided for education, training and loan forgiveness programs as part of a dynamic planning process to bolster the primary care and nursing workforce.

Just last week, commercial insurers made their first overture in an effort to work with the rising tides of reform by proposing to end the long-standing policy of charging high rates for sick customers (MDD, March 26, 2009).

In making specific suggestions, the Health Reform Dialogue group is using the following principles as cornerstones for healthcare reform:

Healthcare coverage options should be expanded to extend insurance to the 46 million Americans who are uninsured;

Healthcare costs should be reduced by increasing value for American healthcare consumers. Key reforms include implementing Medicare payment reforms, improving billing efficiencies, closing gaps in quality and outcomes; and

An environment should be fostered in which prevention, wellness and primary care not just diagnosis and treatment are the cornerstones of high-quality care, and more.

"We're sending a message that healthcare reform has become the art of the possible," said Mary Grealy, president, Healthcare Leadership Council (Washington). Organizations with diverse views have forged common ground on measures to strengthen quality and cost-effectiveness while extending health coverage to all Americans. This collaboration is an important step in making health reform a reality this year."

Among others, the Health Reform Dialogue group represents employers, workers, hospitals, nurses, physicians, insurers and consumers. While they acknowledge consensus on certain issues, they are trying to work through and around differing views.

"We entered this process knowing that the issues are complex, and with no illusions that these groups would reach agreement on every aspect of reform. But the diversity of perspectives that were shared at one table, and the spirit of commitment from all sides, made these discussions totally unlike anything that happened in 1994, and that bodes well," said Rich Umbdenstock, president/CEO of American Hospital Association (Chicago). "Now more than ever before, all of us agree that fundamental reform of the nation's health care system is critical right now, this year and is essential for every sector of society. The American people want bipartisan, responsible reform, and all of us do, too."

The group drilled down in its report to more specific recommendations to insure all Americans receive quality healthcare and also put into perspective how these improvements should be financed.

"The Congressional Budget Office estimates that total health spending will rise from 16% of gross domestic product in 2007 to 25% in 2025," according to the report. First and foremost, cost efficiencies can be gained by improving healthcare delivery. Then, methodologies for quantifying long-term cost savings should be improved, emphasizing the "importance of evaluating the longer-term impact of reform ideas rather than just short-term results."

Ultimately, more money is needed to fund the reforms and improvements.

"To jump start health reform, additional investments in U.S. healthcare will be needed," according to the report. "A more flexible approach to financing health reform is required that reaffirms the importance of offsets, but accommodates the need for significant short-term expenditures and will help set the health system on a path toward significant long-term savings and improvement in the long-term fiscal future of our country."

Past attempts to reform healthcare in the U.S. have failed. But Nexon said he thinks reform has a decent chance of happening this year.

"I give healthcare reform a 50/50 chance to happen this year," he said. "The tremendous leadership of President Obama and the fact that groups like this one have been able to come together and said they want change and go beyond the cliches makes me feel optimistic."

Others participating in the Health Reform Dialogue include: AARP (Washington), America's Health Insurance Plans (Washington), American Cancer Society Cancer Action Network (Atlanta), American College of Physicians (Philadelphia), American Medical Association (Chicago), American Nurses Association (Silver Spring, Maryland), Blue Cross and Blue Shield Association (Chicago), Business Roundtable (Washington), Catholic Health Association of the United States (Washington), Families USA (Washington), Federation of American Hospitals (Washington), National Federation of Independent Business (Nashville, Tennessee), Pharmaceutical Research and Manufacturers of America (Washington) and U.S. Chamber of Commerce (Washington).

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