Ned's Plan for Affordable, Accessible Health Care
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Ned's Plan for Affordable, Accessible Health Care
Introduction
Health coverage in Connecticut is phenomenally expensive. We spend more per person than all but five states,1 and the average family premium for employer-based insurance now surpasses $13,000.2 Health care costs are breaking the bank for small businesses, families, and state government-$7 billion of our $19 billion budget goes to health care.3
Despite such spending, most of us know firsthand the problems of our health care system: eye-watering paperwork, long waits, disparities in access, and inconvenient office hours. And those with insurance are the lucky ones-over 400,000 Connecticut residents-1 in 7-lack coverage at all. 4We need to spend less and get more.
Connecticut families and businesses can neither afford nor accept the status quo. As governor, I will lead bold, sweeping reform of our health care system, building on federal legislation and the state's own efforts. Although it won't all happen overnight, I will implement state-of-the-art health IT, change how we deliver care, promote healthy lifestyles, treat mental health at parity with physical health, and make sure those who need long-term care can choose to stay in their homes if possible.
With these reforms, Connecticut and its entrepreneurs can lead the way in health care innovation-what we pioneer here can spread nationwide. We can also save money. We can save Connecticut families more than $30 billion over the next decade, and shave $900 million/year off projected state Medicaid spending by 2025.
What we need is leadership. In 2006, I stood up to the political establishment, and I will stand up again, to all those who say reform is just too hard. Together, we can provide better care to more people at lower cost. It is a moral imperative-and an economic necessity-to reform health care in Connecticut, and I have a plan to do just that.
Where Does the Money Go and What Can We Do?
Throughout our health care system, for people of all ages, we have a problem-waste, inefficiency, and unnecessary care. We must improve the management and practice of health care to reduce cost, while assuring quality is not compromised.
1. Health Information Technology (HIT)
We use shockingly little 21st century IT in health care. Not long ago, a report found Medicaid applications being filed, then couriered to the DSS Central Office, where they were then sorted and sent to district offices for processing.5 At best, it took four employees and days. It could have been one employee and seconds.
We need automated systems that provide the right information to everyone, so that one doctor knows what tests another performed, so the ER nurse knows what medications you're on, so patients can see the cost of care and quality of providers. We all make better choices when we are well informed.
Staggering costs stem from inconsistent treatments and medications. Patients with multiple diseases, the elderly in particular, can't be expected to remember every medication and diagnosis from a half dozen doctors. Electronic health records are critical. As governor, I will wire Connecticut's hospitals and doctor's offices like I wired college campuses across the United States.
- I will use the state's $7 billion in health care purchasing power to drive change. I will encourage a basic level of HIT and offer incentives to providers going the extra mile.
- I will aggressively support Connecticut providers in their pursuit of federal funding for HIT and work closely with eHealthConnecticut to guide providers in its implementation.
- I will encourage consistent HIT standards across the state. Different local systems should be able to talk with one another so that critical medical records are available when needed, wherever the patient may be.
- I will work to provide patients with more information. The price and quality of a given treatment can vary dramatically from hospital to hospital; by letting people comparison-shop, we can bring down costs and raise up quality.
A well-regarded study by Rand found HIT-related savings could reach $12 billion over the next 10 years in Massachusetts. Adjusting for population, Connecticut could save $6.5 billion over a decade.6
2. Health Care Delivery
We must begin reengineering how health care is delivered, producing better outcomes at lower cost. As governor, I will implement proven models from around the country, starting with those groups the state covers, from state employees to HUSKY enrollees. If we support innovation like this, Connecticut and our entrepreneurs can lead the nation.
Pay for results, not activity. Today the most common health care payment method is fee-for-service, which rewards providers for the volume of tests and services they perform rather than for how their patients fare. Instead, we should pay providers one "bundled" payment for all care related to a particular condition, like cataract surgery or congestive heart failure.
The Geisinger Clinic in Pennsylvania does this to great effect. Not only does Geisinger charge a flat rate for coronary bypass surgery and all the testing and care that go with it, they issue a guarantee. If you have to go back in because of a preventable complication, it's on Geisinger. They've seen a 45% decrease in readmission.
Given the incentive to get things right the first time, Geisinger relies on best practices known as "evidence-based medicine." Under these guidelines, Geisinger has seen a 60% drop in neurologic complications for coronary bypass.7
It can be done here too. Payment reform, together with better HIT, will encourage innovation throughout our state's doctor's offices, clinics, and hospitals.
- I will use the state's $7 billion in purchasing power to phase in payment reform over time, starting with the costliest procedures. With $7 billion in the balance, it will make sense for providers to commit to this change.
- I will take advantage of all federal support available for payment reform, making sure we draft first-rate applications for grants coming from the Center for Medicare and Medicaid Innovation.
- I will require providers serving state populations to report quality and safety metrics such as readmissions and hospital-acquired infections. I will provide enhanced reimbursement to the top third of providers to start a race to the top.
Drive primary care coordination and expansion. Every patient deserves an informed caregiver who can quarterback his care-whether in a private office or federally qualified health center.
The key is providing everyone a "medical home," paying providers to work together with patients to personalize care, provide round-the-clock access, and make certain that no one is lost in the system. Coordination leads to better care at lower cost.
Many practices in Connecticut are in the process of developing medical home programs. For instance, ProHealth Physicians will serve more than 100,000 patients using this model. Patients with multiple conditions benefit especially from medical homes; although they account for a small part of the population, they generate half of all medical costs.
Federal reform offers considerable support for primary care providers, but we must make sure they have the capacity to handle the coming surge of newly insured. Already, too many people use the emergency room for non-urgent care. Many have insurance but go because their doctor's offices aren't open after work.9 This is not acceptable. We must make primary care available where and when people need it.
- I will push for medical homes for groups covered by the state, and make every effort to participate in federal pilot programs and receive grants for medical homes.
- I will encourage employer-based clinics, so care is available when and where employees need it, and I will support expansion of federally qualified health centers.
- I will work to have all clinical professionals, like physician assistants, working at the "top of their licenses"-we will need all their help to deal with the wave of new primary care patients.
- I will provide loan repayment for students at our state colleges and universities who train for and practice primary care in state after graduation.
Based on Rand's study of Massachusetts, Connecticut could save $3 billion over the next 10 years by moving to the medical home model.10
Encourage patients to make better health choices. Billions of dollars are wasted because patients don't follow through on their treatments. This means dollars spent on medicine not taken, and on more expensive treatments when conditions worsen as a result. We need to encourage patients to be more engaged in and accountable for their own health.
Consumer-driven health plans and value-based benefit design are two ways to encourage people to follow the doctor's orders, rewarding them for taking better care of themselves. Companies with these plans, like Pitney Bowes, have given money freed from health care back to employees in the form of lower insurance premiums and bigger 401(k) contributions.
- I will create a program to reward state employees who take care of themselves. We'll reduce co-pays or give rewards, like a $50 savings bond for expecting mothers who go to all of their prenatal care visits.
- I will bring together employers with and without consumer-driven health plans and value-based benefit designs so they can share cutting-edge practices.