The document discusses the need for healthcare reform in the United States. It notes that around 47 million Americans are uninsured, 50 million are underinsured, and 79 million struggle with medical debt. It argues that the current healthcare system lacks an organizing principle to effectively link resources into a high value system. Reform is necessary to address issues like a lack of coordinated care, high costs, inconsistent quality, and an inefficient use of resources. The document advocates for a patient-centered medical home model and insurance reforms influenced by state-level decisions around insurance exchanges.

2. David C. Lewis, M.D. Professor Emeritus of Community Health and Medicine Donald G. Millar Distinguished emeritus Professor of Alcohol and Addiction Studies Brown University [email_address]

3. Individualism Federalism Pluralism Incrementalism American Political Character

4. The Problem “ The American health care system is the poster child for underachievement…The largest limiting factor is not lack of money, technology, information, or even people but rather a lack of an organizing principle that can link money, people, technology, and ideas into a system that delivers more cost-effective care (in other words, more value) than current arrangements.” Source: Stephen M. Shortell and Julie Schmittdiel, in Toward a 21 st Century Health System , edited by Alain C. Enthoven an dLaura Tollen, 2004.

5. Healthcare Reform

6. Reform is Necessary 47 million are uninsured 50 million are underinsured 79 million struggle with medical debt Lack of coordinated care High cost, low value for the dollar Inconsistent quality Inefficient use of resources Care is not patient-centered Professional judgment challenged

8. BIGGEST COSTS HOSPITAL READMISSIONS SPECIALIST SERVICES

9. Patient-Centered Medical Home Personal physician Whole Person Orientation Physician Directed Medical Practice Care is Coordinated and/or Integrated Quality and Safety Enhanced Access Payment Reform

10. INSURANCE REFORM WILL BE INFLUENCED BY STATE BASED DECISIONS ABOUT DESIGN OF EXCHANGES VIABILITY OF EMPLOYER BASED COVERAGE COMPARATIVE EFFECTIVENESS RESEARCH

11. Ensure that governing boards and other advisory bodies tasked with developing and administering the Exchanges include individuals with expertise regarding the unique needs of individuals with mental health and/or substance use disorders.

12. Recognize and enforce the essential health benefits requirements of the Exchanges. This includes the requirement that comprehensive mental health and substance use disorder benefits, at parity with medical/surgical benefits, be covered by all plans participating in the Exchanges.

13. Ensure a strong outreach and education component, targeted to the public, eligible employers, and service providers to ensure sufficient access to coverage and benefits.

14. Determinations about who needs what services, levels of care, and lengths of stay must be made by professionals treating the patient, and medical management tools cannot be used inappropriately to deny needed care.