DeParle: Healthcare Reform Moving Steadily Forward

Janice Simmons, for HealthLeaders Media , April 16, 2009

On the calendar, Congress is still officially in the middle of its two-week spring recess, but behind the scenes on Capitol Hill, work on healthcare reform has been quietly continuing, according to Nancy Ann DeParle, director of the White House's newly created Office of Health Reform.

DeParle, who has been in her new position for just a month, has been spending 60% to 75% of her time there talking with congressional members and staff who appear far more receptive to a reform package than they did more than 15 years ago. She also says that many other healthcare stakeholders are more open to reform efforts, including healthcare providers, employers, and business groups.

"What I found remarkable is that no one [group] wants the status quo. They don't start off talking about their position. They talk about how we can get everyone covered," said DeParle at media briefing yesterday sponsored by the Kaiser Family Foundation. But this dialogue is not coming from the business community or consumer groups alone but "from the providers themselves. They understand that healthcare costs are out of control and [that's] something that we have to get ahold of."

DeParle, the former administrator of what is now the Centers for Medicare and Medicaid Services, said that unlike the reform efforts during the Clinton administration, "Congress has put its money where its mouth is" and has already enacted a budget resolution that has healthcare reform and a healthcare reserve fund in the budget.

"The administration is providing them with what I'll call active technical assistance and guidance," DeParle said. In Congress, "it's very active work going on," with two Senate committees and three House committees involved in the issue.

"I found the both sides of the aisle were in agreement with the president's principles. While they don't agree on every single point in his plan, they are all saying that they want to work with us constructively," she said. She predicted that at the current course, reform legislation could be ready in both houses by this summer.

But many issues of concern still need to be hammered out, including reforming the Medicare payment system. A number of proposals were made by the president, for instance, to address inequities in the current Medicare Advantage program and to move to a more competitive Medicare system.

This includes the bundling of payments "to get better incentives for hospitals to prevent readmissions" so that they are not encouraged to let patients out early "who haven't received all the care they need—and then they come right back to the hospital," she said. "Those are truly payment reforms—they're not just the usual suspects in Medicare."

"This could extend the Medicare trust fund by at least two years. [This is] a down payment on what needs to be done for Medicare," she said.

In addition, other areas which are expected to have "big impacts on Medicare and Medicaid long term," are receiving interest including the use of health information technology, electronic medical records, and health and wellness promotion.

Also, a review of comparative effectiveness in healthcare, which was included in the stimulus package, will help providers, patients and health plans get a start with "the information they need to really know on which treatments are going to work best for which patients," she said. "That hasn't been out there before, and we expect that to have an impact long term."

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at

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