Long-view on health reform

By Frances G. Padilla
President, Universal Health Care Foundation of Connecticut

Frances - use this oneWhen the Strategy Subcommittee of Access Health CT, the new health insurance marketplace, asks for provocative ideas, that’s an encouraging sign for the people of Connecticut. And it was a welcome challenge for a group of colleagues and me recently.

Last week, the co-chairs of two Work Groups of the Governor’s Health Care Cabinet met with the Subcommittee to discuss ways we can create fundamental change in the state’s health care system. Pat Baker, president of the Connecticut Health Foundation and Pat Rehmer, commissioner of the Department of Mental Health and Addiction Services represented the Delivery System Innovation Work Group. Nancy Yedlin, vice president of the Donaghue Foundation and I represented the Business Plan Development Work Group.

As changes under the Affordable Care Act (ACA), commonly called Obamacare, get underway, concerns about affordability are widespread.  The co-chairs of the two work groups had a great dialog with the Strategy Subcommittee members.  We talked about how the way we pay for care and the way we organize care can actually improve quality while reining in costs.

For example, right now doctors and facilities are paid based on how many patients they see – pure volume, like they are piece workers on an assembly line. A shift to a payment system that rewards quality and doesn’t reward errors and ineffective care could be a game changer.  It would allow providers to spend the time necessary to educate and empower patients to better control chronic health conditions like high blood pressure or diabetes.  Expensive complications requiring hospitalization would be avoided and patients’ quality of life would be improved.

We also discussed how the state could leverage the dollars it spends on health care to move delivery system change forward.  State government pays for two of the largest pools of insured individuals in Connecticut – state employees and Medicaid. Already those dollars are being used to promote an innovative model of care for both groups, known as the Patient Centered Medical Home.  This model of care is focused on primary care, prevention and patient education, again an approach that can keep people healthy and help them avoid expensive procedures down the road.  Because so many people in Connecticut are covered by these two large groups, more and more physician offices and community health centers are adopting this model of care, something that benefits all of the patients they serve.  This is just one example of several programs underway that are changing the face of health care in our state.  Still, as we pointed out, much more could be done to use our state health dollars to promote changes in the system from which all could benefit.

Robert Scalettar, M.D. the co-chair of the Strategy subcommittee, discussed the work the state is undertaking to establish an All-Payer Claims Database.  In the current system, patients, as well as providers, are hard-pressed to find the prices of health care treatments and services in the state.  This project will allow consumers to compare the price that different health facilities charge for the same procedure. Price competition will lead to lower costs.  But it will also have an impact on quality. “If we got to a point where we had real price and cost transparency then it would move us to a place where competition was on actual outcomes,” said Nancy Yedlin, my co-chair from the Cabinet’s Business Plan Work Group.

Speaking of competition, I also talked about the importance of adding more competitors, particularly non-profits that focus on innovative care delivery, to the insurance market in Connecticut.  The recent licensure of HealthyCT, a non-profit, patient-centered, health insurance CO-OP, is welcome news for our state.

HealthyCT will be a new insurance choice as the insurance marketplace, Access Health CT, begins offering health coverage to the uninsured in our state on October 1, with the coverage kicking in on January 1.  Although subsidies will be available to help lower and middle income residents afford premiums, many are concerned that the cost of coverage, including co-pays and deductibles, will still be too high.  As a major purchaser of health care, Access Health CT has the opportunity to use its clout to push the system in the right direction.

I’m glad the leaders of Access Health CT are soliciting ideas for how they can use their purchasing power to ensure we all get the care we deserve at a price we can afford.

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