fixing the u s health system state by state
Download
Skip this Video
Download Presentation
Fixing The U.S. Health System State By State

Loading in 2 Seconds...

play fullscreen
1 / 34

Fixing The U.S. Health System State By State - PowerPoint PPT Presentation


  • 72 Views
  • Uploaded on

Fixing The U.S. Health System State By State. Stephen C. Schoenbaum, MD, MPH Executive Vice President for Programs April 26, 2007 www.cmwf.org Kentucky Institute of Medicine. Commonwealth Fund’s Commission on a High Performance Health System. Objective:

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Fixing The U.S. Health System State By State' - merrill


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
fixing the u s health system state by state

Fixing The U.S. Health System State By State

Stephen C. Schoenbaum, MD, MPH

Executive Vice President for Programs

April 26, 2007

www.cmwf.org

Kentucky Institute of Medicine

commonwealth fund s commission on a high performance health system
Commonwealth Fund’s Commission on a High Performance Health System

Objective:

  • The overarching mission of a high performance health care system is to help everyone, to the extent possible, lead long, healthy, and productive lives
  • To the Commission, a high performance health system is designed to achieve four core goals
    • high quality, safe care
    • access to care for all people
    • efficient, high value
    • system capacity to improve
us scorecard us falls short of benchmarks on all dimensions of a high performance health system
US Scorecard: US Falls Short of Benchmarks on All Dimensions of a High Performance Health System

SOURCE: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006

state health system performance summary

Top Quarter

2nd Quarter

3rd Quarter

Bottom Quarter

State Health System Performance Summary
lessons from the scorecard
Lessons From The Scorecard
  • Care far from “perfect”
  • Tremendous variation within the US
  • Possible to have higher quality and lower cost
  • We need to address multiple issues simultaneously – e.g., coverage, efficiency, quality
the discourse is changing
The Discourse Is Changing

FROM:

  • “Americans have the best health care system in the world”
        • President Bush, State of the Union Speech, 2004

TO:

  • We need to do better
    • We spend more on health care than any other country
    • We need more value for what we are spending
keys to transforming the u s health care system
Keys to Transforming the U.S. Health Care System
  • Extend health insurance coverage to all
  • Pursue excellence in provision of safe, effective, and efficient care
  • Organize the care system to ensure coordinated and accessible care for all
  • Increase transparency and reward quality and efficiency
  • Expand the use of information technology and information exchange
  • Develop the workforce to foster patient-centered and primary care
  • Encourage leadership and collaboration among public and private stakeholders
uninsured non elderly adult rate rapidly deteriorating

ACCESS: UNIVERSAL PARTICIPATION

1999–2000

2004–2005

NH

NH

ME

WA

NH

VT

ME

WA

VT

ND

MT

ND

MT

MN

MN

OR

NY

MA

WI

OR

MA

NY

ID

SD

WI

RI

MI

ID

SD

RI

WY

MI

CT

PA

WY

NJ

CT

IA

PA

NJ

NE

IA

OH

DE

IN

NE

OH

NV

DE

IN

IL

MD

NV

WV

UT

VA

IL

MD

CO

DC

WV

UT

VA

KS

MO

KY

CA

CO

DC

KS

MO

KY

CA

NC

NC

TN

TN

OK

SC

AR

OK

AZ

NM

SC

AR

AZ

NM

MS

GA

AL

MS

GA

AL

TX

LA

TX

LA

FL

FL

AK

AK

23% or more

HI

HI

19%–22.9%

14%–18.9%

Less than 14%

Uninsured Non-Elderly Adult Rate Rapidly Deteriorating

Data: Two-year averages 1999–2000 and 2004–2005 from the Census Bureau’s March 2000, 2001 and 2005, 2006 Current Population Surveys. Estimates by the Employee Benefit Research Institute.

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006

percent of uninsured children declined since implementation of schip

ACCESS: UNIVERSAL PARTICIPATION

1999–2000

2004–2005

NH

ME

WA

NH

VT

ME

WA

VT

ND

MT

ND

MT

MN

MN

OR

NY

MA

WI

OR

MA

NY

ID

SD

WI

RI

MI

ID

SD

RI

WY

MI

CT

PA

WY

NJ

CT

IA

PA

NJ

NE

IA

OH

DE

IN

NE

OH

NV

DE

IN

IL

MD

NV

WV

UT

VA

IL

MD

CO

DC

WV

UT

VA

KS

MO

KY

CA

CO

DC

KS

MO

KY

CA

NC

NC

TN

TN

OK

SC

AR

OK

AZ

NM

SC

AR

AZ

NM

MS

GA

AL

MS

GA

AL

TX

LA

TX

LA

FL

FL

AK

AK

16% or more

HI

HI

10%–15.9%

7%–9.9%

Less than 7%

Percent of Uninsured Children Declined Since Implementation of SCHIP

Data: Two-year averages 1999–2000 and 2004–2005 from the Census Bureau’s March 2000, 2001 and 2005, 2006 Current Population Surveys. Estimates by the Employee Benefit Research Institute.

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006

state action on employer coverage
State Action on Employer Coverage

In 2006, nearly 30 states considered bills to require employers to offer health insurance or pay in some way to cover the uninsured. So far in 2007, similar plans have been proposed in 14 states.

2006 legislation passed

2007 proposals introduced

2006 legislation failed but 2007 proposals introduced

Sources: National Conference on State Legislatures and American Legislative Exchange Council

2006 legislation failed

massachusetts health care reform
Massachusetts Health Care Reform
  • Enacted 4/06
  • MassHealth expansion for children up to 300% FPL; adults up to 100% poverty
  • Individual mandate, with affordability provision; subsidies between 100% and 300% of poverty
  • Employer mandatory offer, employee mandatory take-up
  • Employer assessment ($295 if employer doesn’t provide health insurance)
  • “Connector” to organize affordable insurance offerings through a group pool

Source: John Holahan, “The Basics of Massachusetts Health Reform,” Presentation to United Hospital Fund, April 2006.

update massachusetts health care reform
Update: Massachusetts Health Care Reform
  • The Commonwealth Connector Authority approved draft regulations on creditable coverage:
    • Prescription drugs
    • Coverage of preventive services prior to deductible
    • Caps on annual deductible and out of pocket costs for hospital and physician services
    • No limits on benefits per year per sickness
  • New plans called Commonwealth Choice go on sale May 1 and go into effect July 1, 2007
  • Deductibles range from $0 to $2,000
  • Phased-in “minimum coverage” requirement, fully in effect January 1, 2009
  • Connector Authority currently developing criteria for exempting individuals from requirement
massachusetts strategies for coverage everyone does their part
Massachusetts Strategies for Coverage: Everyone “does their part”

Government

Health Care

System

  • Subsidized insurance
  • The Connector
  • Uncompensated Care pool reform
  • Improved Medicaid reimbursement
  • Meet quality and performance standards
  • New levels of “transparency”

Expanded

Coverage

Employers

Individuals

  • Fair Share Assessment
  • “Free Rider” provisions
  • Mandatory “cafeteria plans”
  • Individual Mandate

Source: Adapted from Amy Lischko, October 16, 2006. “Massachusetts Health Reform.” NASHP 19th Annual State Health Policy Conference, Pittsburgh, PA.

small business programs
Small Business Programs
  • Montana: Insure Montana (2-9- employees)
    • Refundable tax credits ($100-125/employee/month)
    • Small business purchasing pool (subsidized from increased tobacco tax)
    • 8000 enrollees in first year
  • New Mexico: State Coverage Insurance (<50 employees)
    • Waiver to expand Medicaid eligibility to uninsured working adults <200% FPL
    • 4400 enrollees, Fall 2006
states targeting employees of small businesses
States Targeting Employees of Small Businesses
  • Oklahoma: Insure Oklahoma (<50 employees):
    • Premium assistance pays 60% of premium for low income workers; employer pays 25%; employee pays up to 15%.
    • Funded from tobacco tax, federal Medicaid match, and employer/employee contributions
    • 1200 enrollees
  • New York: Healthy New York (small employers with 30% or more employees earning < $34,000)
    • State reinsurance keeps premiums affordable
    • 125,000 enrollees, Fall 2006
covertn
CoverTN
  • Limited-benefit “minimedical” plan launched by Governor Phil Bredesen in March 2007 to offer low-cost insurance to small businesses and uninsured working Tennesseans
  • Administered by BlueCross Blue Shield; Premiums shared by employer, employee, and the state. Each pay between $34 - $99/month.
  • Option of two plans, both with no deductible and modest co-pays ($15-$20 for doctor visits; $100 for hospital stays).
    • Plan A: Covers hospital stays up to $15,000 per year and up to $75 every three months for drugs
    • Plan B: Covers hospital stays up to $10,000 per year and up to $250 every three months for drugs
  • Currently enrolled: 1,053 individuals; 89 hospitals; 10,000 physicians; 12,000 businesses pre-qualified
new jersey raises age of dependent status for health insurance
New Jersey Raises Age of Dependent Status for Health Insurance

Millions uninsured, adults ages 19–29

  • As of 5/2006, NJ requires all state insurers to raise dependent age limit to 30
    • Highest age limit in country
    • Covers uninsured, unmarried adults with no dependents who are either NJ residents or full-time students
    • Premium capped at 102% of amount paid for dependent’s coverage prior to aging out
  • 200,000 young adults expected to receive coverage under the law

Source: S.R. Collins, C. Schoen, J.L. Kriss, M.M. Doty, B. Mahato, “Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help,” Commonwealth Fund issue brief, May 2006. (Analysis of the March 2001–2005 Current Population Surveys)

illinois all kids
Illinois All-Kids
  • Effective July 1, 2006
  • Available to any child uninsured for 12 months or more
  • Cost to family determined on a sliding scale
  • Linked to other public programs - FamilyCare & KidCare
  • Funded by federal and state funds
    • Children <200% of the federal poverty level funded by federal funds
    • Children 200%+ of the federal poverty level funded by state savings from the Medicaid Primary Care Case Management Program
  • All-Kids Training Tour
    • Public outreach program to highlight new and expanded healthcare programs
  • Enrollment as of Fall 2006 was 28,600
california governor s proposal 1 07
California Governor’s Proposal (1/07)
  • Individual mandate
  • Shared responsibility
  • Medi-Cal expansion
    • All children below 300% poverty
    • Adults below 100% poverty
  • Premium subsidies for adults below 250% poverty
  • Employers must provide health insurance or pay a fee of 4% of wages
  • Provider fee assessment (2% of physician revenues to 4% of hospital revenues)
  • Insurance exchange
    • Guaranteed issue; community rating with age bands
    • 85% minimum medical loss ratio

Source: D. Rowland, “California Health Reform Proposal,” Kaiser Commission on Medicaid and the Uninsured, Presented January 13, 2007.

extending coverage is only one piece of the puzzle
Extending Coverage is Only One Piece of the Puzzle

3. Organize the Care System to Ensure Coordinated and Accessible Care for All

1. Extend Health Insurance Coverage to All

2. Pursue Excellence in Provision of Safe, Effective, and Efficient Care

7. Encourage Leadership

and Collabor-

ation Among

Public

5. Expand the Use of Information Technology and Exchange

4. Increase Transparency and Reward Quality and Efficiency

And Private Stakeholders

6. Develop the Workforce to Foster Patient-Centered and Primary Care

delaware health information exchange
Delaware Health Information Exchange
  • Delaware Health Information Network
    • Public-private partnership established in 1997 to assist in the creation of a statewide health information and electronic data interchange network for public and private use.
    • Functions under the direction of the Delaware Health Care Commission.
    • In 2006 signed an extendable 6-year contract with technology vendor Medicity, Inc. to create the first statewide health information exchange (Start-up costs =$4 to 5 million).
  • Interoperable Health Information Exchange
    • Gives physicians access to secure, fast, and reliable electronic patient information at the time and place of care.
    • Funded by participating health care organizations, the State of Delaware, and the Federal Agency for Healthcare Research and Quality in the U.S. Department of Health and Human Services.
community care of north carolina
Community Care of North Carolina

Asthma Initiative: Pediatric Asthma Hospitalization

Rates (April 2000 – December 2002)

  • 15 networks, 3500 MDs, >750,000 patients
  • Receive $2.50 PM/PM from the State
  • Hire care managers/medical management staff
  • PCP also get $2.50 PMPM to serve as medical home and to participate in disease management
  • Care improvement: asthma, diabetes, screening/referral of young children for developmental problems, and more!
  • Case management: identify and facilitate management of costly patients
  • Cost (FY2003) - $8.1 Million; Savings (per Mercer analysis) $60M compared to FY2002

In patient admission rate per 1000

member months

Source: L. Allen Dobson, MD, presentation to ERISA Industry Committee, Washington, DC, March 12, 2007

building quality into rite care higher quality and improved cost trends
Building Quality Into RIte CareHigher Quality and Improved Cost Trends

Cumulative Health Insurance Cost Trend Comparison

Percent

  • Quality targets and $ incentives
  • Improved access, medical home
    • One third reduction in hospital and ER
    • Tripled primary care doctors
    • Doubled clinic visits
  • Significant improvements in prenatal care, birth spacing, lead paint, infant mortality, preventive care

Source: Silow-Carroll, Building Quality into RIte Care, Commonwealth Fund, 2003.Tricia Leddy, Outcome Update, Presentation at Princeton Conference, May 20, 2005; updated.

prescription for pennsylvania 1 07
Prescription for Pennsylvania (1/07)
  • Affordable basic health insurance for all
  • Promote non-emergency settings for non-emergency care
  • Improve quality by eliminating hospital-acquired infections, medical errors
  • Pay-for-performance
  • Long-term care: promote home/community services
  • Enhance pain-management, palliative care, and hospice care
  • Promote wellness and sound nutrition in the schools and by making workplaces, restaurants, and bars smoke-free
ways states can promote a high performance health system
Ways States Can Promote a High Performance Health System
  • Extend coverage – ideally to all
  • Reduce cost shifting by adequate funding of public programs
  • Simplify and streamline public program eligibility and re-determination
  • Promote safer care
    • Reporting, analysis, technical assistance
  • Promote more effective, efficient, patient-centered, timely, and coordinated care
    • Public reporting
    • Payment policies – “value-based purchasing”
  • Assure competent professionals
    • Licensure, maintenance of competence, discipline
  • Promote the use of health information technology
    • State-wide information exchanges, capital loans, technical assistance
  • Promote wellness and healthy living
in sum
In Sum:
  • Efforts at the state level to expand access, improve quality and efficiency are gaining momentum
  • States are learning from each other
  • States are informing the national debate
acknowledgements
Acknowledgements

Karen Davis,

President

The Commonwealth Fund

Cathy Schoen,

Sr. Vice President

Research & Evaluation

Anne Gauthier,

Senior Policy Director

Commission on a High Performance Health System

Elizabeth Sturla,

Executive Assistant

Rachel Nuzum,

Program Officer

State Innovations

Visit the Fund at:www.cmwf.org

ad