New ideas, better outcomes for health reform: big-ticket items such as Medicare spending, coverage of pre-existing conditions and caps on insurance premiums earned the lion's share of health-care reform attention. But advocates say innovations such as value-based payments, telemedicine and the "medical home" should have played a larger role in the national dialogue.

• Author: Ladd, Scott
• Position: HEALTH CARE

During the more than year-long debate over how to fix a broken American health-care system, countless ideas have been floated--enough to fill a 2,000-plus legislative bill, and then some. Many recommendations have slipped completely through the legislative discussion cracks. And many never saw enough light of day to make a meaningful impact.

In terms of cost, accessibility, innovation and connectivity, many prescriptive ideas were either arbitrarily dismissed, discarded as too complicated, thought to have little short-term value, found to be political inexpedient or couldn't be reduced to neat "bumper sticker" messages.

For companies and individuals With a stake in systemic reform, some worthy notions of effective reform--those that have either been discarded altogether or found it difficult to gain sufficient traction--should be revisited and addressed in a fuller and more comprehensive way, reform advocates say.

Start with technological advances and innovative approaches that go beyond shop-worn 20th century-level programs to workable 21st century solutions. Think restructuring current public programs to encourage efficient funding channels and management and reduce administrative overlap. Consider a 180-degree turn on long-held views of how providers and patients should interact.

Some of the leading advocates in the comprehensive health-care reform debate--legislators, healthcare executives, financial officers and other stakeholders--maintain strong views about what hasn't been adequately explored, and what should be. Here are a few of those ideas:

Value-based Payments

The concept of quality versus quantity has grabbed its share of the reform spotlight in legislative Washington. But the devil is in the details, and too many of those details didn't get enough of a public airing. Take the question of value-based payments, for instance. Not all medical treatments are created equal--and shouldn't be compensated as such. Individual co-payments for treatments should be based on need; treatments for diabetes should cost consumers less than nonessential services, says Michael Millenson, a health-care consultant and author. Patients certainly should have the choice of expensive procedures that may not be medically critical, but should also know that they'll be paying a bigger chunk of the bill themselves.

Millenson insists clinical value must be the guiding principle in setting medical cost structures. "Where this gets most interesting, and where...