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Publications by Robert A. Berenson for Retirement Policy

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More about Robert A. Berenson's areas of expertise can be found on this Urban Institute expert's page.

Growing evidence demonstrates that certain approaches to financing and paying for chronic care coordination for patients are effective not only for improving patient well-being but can also reduce health care spending. However, chronic care approaches should vary for different patient populations and can be carried out effectively by diverse organizations and professionals reflecting the heterogeneity of health care delivery throughout the US. The Report considers the different populations in need of care coordination, summarizes current evidence of effectiveness, describes the various entities that can serve as focal points for coordinating care, and details the possible financing and payment options that can support these approaches.

In testimony before the Senate Finance Committee, Robert Berenson, M.D. explores possible reasons that integrated care organizations that include multispecialty group practices have not become a major feature of the U.S. health system despite prominent success stories. These organizations are often penalized financially for undertaking activities that reduce costs because the benefits of efficiency are not internalized to the organization. Berenson makes the case that current payment incentives embedded in Medicare and private payer approaches promote behavior that may not benefit patients, such as rewarding preventable hospitalizations and producing a mismatch between the services patients need and those that fee schedules encourage.

Senior fellow Robert Berenson, testifying before the House Ways and Means Health Subcommittee on physician payment reform options in Medicare, argued that long-term approaches need to include bundled payments as an alternative to traditional fee-for-service payments, especially for primary care physicians caring for patients with chronic conditions. Because these reforms are operationally challenging and will require demonstrations of effectiveness, Berenson also suggested reforms to the existing resource-based relative value scale (the basis for the Medicare Fee Schedule) that could be implemented immediately.

The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) raised payment levels for established Medicare Advantage (private) local plans and would-be regional preferred provider organizations (PPOs). Even though plans on average receive about 108 percent of what would have been spent for the same beneficiaries in traditional Medicare, the Centers for Medicare and Medicaid Services (CMS) added another 2.3 percent in 2004 and 4.0 percent in 2005 in its implementation of risk-adjusted payments. Although MMA gives a clear preference to private plans to start a fundamental restructuring of Medicare, the question remains whether Congress will maintain overpayments to private plans when faced with the pressure to reduce budget deficits. (Robert Berenson. December 15, 2004. Health Affairs web exclusive.)

Statement of Robert A. Berenson, M.D. before a hearing of the House Ways and Means Committee's Subcommittee on Health. Berenson addresses the Medicare Chronic Care Improvement Program and the challenges of better serving the growing number of Medicare beneficiaries with multiple and complex chronic conditions, such as chronic obstructive pulmonary disease, congestive heart failure, diabetes mellitus, and other diseases.

While Medicare spending varies widely across the country, increased local spending apparently does not produce differences in quality, access, or even patient satisfaction. Yet policy analysts tend to minimize the importance that as much as 30% of Medicare spending in particular high-spending areas might be excessive and unnecessary. Under most visions of the future of Medicare, there is an imperative to transform the traditional Medicare program from a claims payer to a strategic purchaser, able to adopt a broad array of approaches and use a comprehensive set of tools, some of which are used by private plans, but in a more transparent and accountable way, consistent with Medicare's role as a broad-based social health insurance program.

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