Amid all of the attention being paid to the immediate success or failure of the public health insurance exchanges, dribbles of data indicate that progress is being made in curbing costs and improving quality, in short, realizing the value proposition.
Four recent reports individually don't say a lot, but as a group they might be a sign of success in the effort to remake the way health care is provided in this country.
Let's start with the major immediate thrust of the Affordable Care Act, reducing the number of uninsured. The percentage of Americans without health insurance fell to 15.9 percent as of February, down from 17.1 percent in the fourth quarter of 2013, according to a poll conducted by Gallup as part of the Gallup- Healthways Well-Being Index.
And Gallup surveyors found that the rate of uninsured Americans fell the most among the poor and blacks, noting that the percentage of uninsured Americans with an annual household income of less than $36,000 dropped by 2.8 percentage points since the fourth quarter to 27.9 percent. The percentage of uninsured blacks fell 2.6 points to 18.3 percent.
Those numbers should only get better as we hit the deadline for enrolling in health insurance on March 31.
Employers, meanwhile, are experiencing health care cost growth that is much closer to the overall rate of inflation in the country than it has been historically, according to a survey by Towers Watson and the National Business Group on Health. The cost of providing health care benefits is expected to rise 4.4 percent, just above last year's growth rate of 4.1 percent, which was a 15-year low. Towers Watson analysts don't think that that is going to satisfy employers — so more changes to cut costs are in store — but such a level of limited growth is going to remove at least some of the pressure on providers.
Speaking of employers, the Leapfrog Group had some good news on the quality front, finding that the rate of early-elective induction of baby delivery fell nationally below the target rate of 5 percent, to 4.6 percent. That's down from 17 percent in 2010. Early-elective deliveries can mean more trips to the neonatal intensive care unit and increased lengths of stay.
Leapfrog, never one to avoid criticizing hospitals, in this case heaped on the praise. "This is one of the most extraordinary examples of progress in health care that I've seen in my career," said Leah Binder, president and CEO of Leapfrog, in a news release. "It shows that public reporting can galvanize change, and that saves lives," Binder said.
Since my wife is a certified nurse-midwife, I have a special interest in this topic, but I think most people would recognize that hospitals have made strong progress in this regard.
The last report I'm thinking of is a policy brief on geographic variation in Medicare spending that isn't really good news, but it's not bad news either. Spurred by clear indications that Medicare spending per beneficiary does vary widely, The Robert Wood Johnson Foundation undertook a review of the situation in a Health Affairs report.
The authors make no recommendation on the matter, but in a backhanded way encourage inaction in the matter, which I agree would be the right way to go. Even if there is geographic variation in spending, Medicare is bound to be altered significantly in coming years, so why spend time battling a problem that is likely to go away as fee-for-service reimbursement is replaced by value-based models.
Do these reports signal all is right in the world of health care? Ha! But they might be a sign that health care is moving in the right direction.
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