1. 1 Gail R. Wilensky Project HOPE July 13, 2009 Scoring Savings: How Can Quality Improvement Reduce Health Care Costs?

2. 2 Major Objectives of Reform Expand coverage (without ing deficit ) Moderate spending Improve quality Most agree on objectives Can be done sequentially or simultaneously

3. 3 To Finance Coverage of $1 – 1.5 Trillion Can separate coverage from cost control/quality improvement -- Like Massachusetts -- Need to revenue and/or govt payment or Can try to use savings from reforming delivery to finance expansions Savings are much tougher and much less certain, plus CBO skepticism

4. 4 Lots of Agreement About Delivery Reform – in Principle Need to reward institutions/clinicians who provide good quality/efficient care Need to develop accountable groups – virtual or real Need to develop good measures of quality, outcomes, risk adj. Getting from here to there is tough Lots to learn; will take time; tricky politics

5. 5 Biggest Concerns If rely on saving to expand coverage --- -- What if they dont materialize? -- Is fall-back compatible with delivery reform? -- How much of a time disconnect is OK? If only expand according to certain revenue -- How much/how fast? Politically OK?