Last week’s CSG/ERC annual meeting in Portland ME included talks by some health policy rock stars.
Sen. Richard Moore, Senate Chair of MA’s Joint Committee on Health Care Financing, spoke in the Value to Volume panel. He described MA’s progress toward rewarding higher quality providers in the state employee health plan, using public reporting, and tiering provider payments as tools. As much of health spending is focused in specialty care, they began there. Challenges included accurately attributing the right patients to the right providers, problems with consumer choice (if there are too few providers available consumers can’t use the economic incentives), and the reliability of provider quality assessments (ratings of providers with very few state employees may not be meaningful). He updated the committee on progress toward statewide cost control. Challenges include workforce shortages (if consumers do not have a choice of providers, cost sharing incentives can’t be effective), creating an all-payer database, public and provider resistance to tiering, adoption by self-insured plans, and creating improvement incentives and tools for low-performing providers. Future plans include statewide health information technology adoption by 2014, requiring meaningful HIT use for licensure, expanding the number of primary care providers, standardizing claims processing, and creating patient and family advisory councils to engage consumers.
Karynlee Harrington, Director of the Dirigo Health Agency, talked about Maine’s progress toward quality-based purchasing. Maine has 39 hospitals for 1.3 million people, ED use is 30% higher than the US average, and has $400 million in avoidable hospitalizations annually, all driven by the fee-for-service environment. In response the legislature created a payment reform workgroup that developed a set of six guiding principles. She outlined the Maine Health Management Coalition that includes the state’s major employers in quality-based payment reform, and the patient-centered medical home initiative with 26 sites currently and plans to grow.
Alan Weil, Executive Director of the National Academy for State Health Policy, described the opportunities and challenges for state policymakers in national health reform. He described choices involved in development of state insurance exchanges, changes to regulation of health insurance, the need to simplify and integrate eligibility systems, address workforce shortages and system capacity, benefit design challenges, challenges for dual eligibles, data needs, population health goals, and engaging the public.
Elliott Fisher, from the Dartmouth Atlas program, described his pioneering work outlining the disconnected goals of our current utilization-based health care system that fosters high health care spending but low quality outcomes. He described how the health care market is different from other markets in that supply can drive its own demand (who says no to a doctor that says you need another test), preference driven care, and too few incentives for effective care. He outlined the need for accountable systems of care (accountable care organizations), thoughtful workforce policies, and end-of-life care.