Health Care Reform May be Scary, But It’s Necessary

E-newsletter Issue #90 | April 12, 2012

Change will be painful and scary, but the health care system cannot continue to function the way it is. Reform is necessary to improve both people’s health and every state’s bottom line. 

That was the message delivered by Ellen Andrews, coordinator of the Health Policy Steering Committee for The Council of State Governments East and executive director of the Connecticut Health Policy Project. She was the featured speaker for CSG’s March 28 webinar, “Value over Volume: Paying for Quality.”

Andrews said the health care system, as it is, doesn’t work. Health care costs are skyrocketing and the care people are receiving is inadequate.

“This is no secret to the American public,” she said. “Only 39 percent are confident they can get safe, effective care when they need it. That means 61 percent are not sure. Americans only get 55 percent of recommended care and one in three Americans report getting unnecessary care or duplicate tests. … We’re paying too much and we’re not getting what we pay for.”

The poor care and high costs aren’t really surprising, said Andrews, because our current system pays for quantity over quality.

“When you pay for every service, for people to make more money they’re going to deliver more services,” she said. “Fee-for-service encourages more services, less coordination, because you don’t get paid for coordination. … It stifles innovation. We also only pay for some kinds of services, generally face-to-face treatment. We don’t pay for email, we don’t pay for group visits, we don’t pay for phone calls, we don’t pay for information on websites. Those all have costs and they can actually add a great deal to the quality of our care, but there’s no reimbursement for that.”

Finding ways to quantify what quality care is and sharing it with the public is important for state legislators.

“This is not a hard sell to voters,” Andrews said. “Ninety-six percent of Americans feel it’s important to have information about the quality of care that is provided by different doctors and hospitals. Eighty-nine percent feel it is important they have information about what the costs are before they actually get the care. What a remarkable concept.”

Providing people information about quality and costs can make a difference. In 2005, the state of Maine joined the Maine Health Management Coalition. The coalition is an employer-led partnership that evaluates and promotes high-quality health care.

“You go to their website, you can plug in a city and see which providers in different areas are providing better care and you have incentives to go to them,” Andrews said. “It’s hospitals and physicians. This year, they’re (the state of Maine) expecting flat funding for their employee plan. How many states wouldn’t want to have that?”

In fact, Andrews said, the cost of treating a member with diabetes was reduced by an average of $1,300 after just the first year.

Getting information to consumers about quality and cost is important, she said.

“Transparency, this is one we kind of tend to gloss over,” said Andrews, “but I think you should pay attention to it. … We’re getting better and better over time in figuring out how to effectively convey information so consumers can use it, so payers can use it and so that providers use it. … Providers can be very competitive, so it’s not a bad thing to put a report card out there. … It can be incredibly motivating, even if it’s not linked to any economic incentives. Everybody wants to be the best.”

Andrews said legislators also should start small with health care reform, run a fair and open process so everybody knows why and how things are changing and have a very strong consumer education piece so residents know the changes are about better health care, not denying them treatment.

“And you need to be brave,” she said. “It’s very scary. I’ve heard that word over and over. It’s scary, but you need to be brave doing this because the health care system is broken. … The status quo is not sustainable.”

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