A health care exchange that pools its enrollees’ bargaining power will help give consumers a better deal on their coverage, but it will need to do more to get the unsustainable rise in health care costs under control. That is because while consumers and businesses pay plenty in premiums and out-of-pocket costs, much of our health care spending does not yield the results that we really want—healthier people. The payment systems used by major insurers, both public and private, are one root of this problem. The widely used fee-for-service payment approach rewards providers for the number and complexity of tests and procedures that can be billed, not the quality of care provided or whether the patient gets healthy.
Fortunately, research and the experience of innovative providers across the country have charted a path toward medical care which can better rein in costs and improve patients’ health. To take that path, providers, rather than spending all their time on an endless stream of paperwork, need to be able to devote more time to their patients. Primary care physicians need to be able to work as a part of a team coordinating with a patients’ other health professionals so that patients get all the care they need while avoiding unnecessary, duplicative, or harmful tests and procedures. And providers need easy access to updated medical records.
But providers will never achieve these wholesale changes in the delivery of care until payers change the way they pay for care. Insurers will need to move towards paying for quality and results, not volume. And the exchange, in its negotiations with insurers, can drive them to adopt these proven strategies, which will improve enrollees’ health and lower overall health care costs.