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February 2009 — Vol. 87, No.1

Coalition focuses on

Healing health care

Business community, hospitals, insurers join to
propose consensus-based reforms

 

There’s no doubt about it. Our health care system is in need of repair. Employers find health care expenses rising faster than other input costs. Providers are unable to generate sufficient patient revenue to cover expenses. Governments fail to meet their reimbursement commitments. Some patients cannot get timely access to optimal care. And far too many individuals remain without health insurance, engage in unhealthy behaviors, and live in unhealthy environments. The question, of course, is what to do about it.

“Everybody agrees that our health care system must be improved,” says John Rathgeber, CBIA president and CEO, “but we need to do it in a smart way—a way that improves quality, lowers costs, increases access, and helps Connecticut’s economy recover and grow. There’s no way to meet our state’s health care needs without a healthy economy and good jobs and the benefits those jobs bring.”

“Any reform plan,” argues Rathgeber, “must do three things: First, it must address lifestyle issues to avoid some preventable diseases, which obviously drive up the cost of health care coverage. Second, it must reduce the cost and upgrade the quality of health care so that we can increase the value of the dollars being spent. And third, it must ensure that no one slips through the cracks, that we get coverage to the uninsured residents of our state. We believe the best way to achieve those goals is to shore up our current, employer-based system, not eradicate it in favor of a state-run system, as some propose. In fact, Connecticut is one of the nation’s leading states in providing employer-sponsored insurance.”

Finally, adds Rathgeber, “health care reform needs to be consensus-driven, because the health care crisis affects everyone. We can’t have winners and
losers, only winners.”

Building consensus

Because of the singular importance of the health care issue, CBIA has forged a coalition of business, health care, and health insurance representatives to set the course for reform. The coalition, comprising CBIA, the Connecticut Hospital Association (CHA), and the Connecticut Association of Health Plans (CTAHP), was established to create and advocate for health care reform principles that build on the strengths of the existing system for covering and delivering care while identifying ways to reduce costs and achieve quality and efficiency.

“We are a diverse group of organizations with often conflicting agendas and issues,” says Patrick Charmel, president and CEO of Griffin Hospital in Derby and CHA chairman, “but we have joined together to advocate for one very important and critical issue: ensuring that all Connecticut residents have access to high-quality, affordable health care coverage and service.”

Four major precepts underpin the coalition’s mission:

1. Our existing market-based, employer-sponsored health care system must be strengthened and bolstered, not abandoned.
2. Reforms must establish a health care system that makes coverage available, affordable, and sustainable for everyone.
3. Government should continue to be the lifeline for those with no attachment to the workforce or who can’t afford coverage.
4. Effective, lasting reform must be based on consensus.

Within those guidelines, the coalition has developed a set of consensus principles of health care reform. The principles draw significantly on the research and policy framework proposed by the Connecticut Health Insurance Policy Council and have shaped CBIA’s health care agenda for 2009 and beyond. Here are the key components of that agenda.

Enhancing quality

Improving quality of health care in Connecticut includes making the changes necessary to reduce medical errors; avoid unnecessary testing; ensure that people get timely, appropriate care with the best possible medical outcomes; and improve the health status of all Connecticut residents. A key part of the quality equation is enabling consumers to compare providers on outcomes and costs so that they can make more-informed decisions about their care.

With those goals in mind, CBIA and its coalition partners urge state policymakers to adopt the following recommendations:
• Use value-based health plan designs that incorporate evidence-based medical practices and outcome measurements in order to give people better care and keep them healthier and more productive. Value-based design requires analyzing data to determine healthy behaviors and optimal medical care in order to encourage those behaviors.
• Work with the private sector to ensure a “medical home” for all Connecticut residents—facilitating greater care coordination among providers, improving the quality of medical care, reducing errors, and providing better chronic-disease management.
• Create public–private partnerships to improve people’s health status through wellness and chronic-disease management programs and incentives for state employees to take advantage of those programs. This will give the state an opportunity to develop strategies in the areas of wellness and disease management that can be shared with and used by the private sector to improve the health status of all Connecticut residents.
• Make health care information more accessible to consumers and make the health care system more efficient by promoting greater use of technology in data collection, transparency, electronic medical records, and e-prescribing.
• Adopt pay-for-performance programs to increase patients’ safety and quality of care. Such programs would incent providers to use evidence-based standards of care and practice guidelines to achieve the best clinical outcomes while reducing costs. Pay-for-performance systems should ameliorate, not exacerbate, the financial challenges already facing providers by offering incentives, not imposing penalties.

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