Lead­ers have op­por­tu­nity to de­sign own re­form

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State lead­ers can guide re­form, for­mer Vt. Gov. Dou­glas says

In early 2009, I de­cided that my chair’s ini­tia­tive for the Na­tional Gov­er­nors As­so­ci­a­tion would cen­ter on im­prov­ing our sys­tem of de­liv­er­ing health­care to the Amer­i­can peo­ple. We didn’t know then whether Congress would pass a com­pre­hen­sive re­form bill and, if so, what it would in­clude. What we did know was that the rapidly ris­ing cost of health­care was out­strip­ping the abil­ity of states to af­ford it. It was ex­ac­er­bated by the re­ces­sion and re­cov­ery, and by gov­ern­ment’s pre­vi­ous ef­forts to ex­pand cov­er­age dur­ing bet­ter fis­cal times. The same pres­sures drive up the cost of in­surance for pub­lic em­ploy­ees and re­tirees as well. Med­i­caid alone is ap­proach­ing a quar­ter of the bud­get in many states and, be­cause it’s an en­ti­tle­ment, it squeezes out other es­sen­tial pro­grams, prin­ci­pally ed­u­ca­tion, which is a sim­i­larly large ex­pen­di­ture.

Much of the na­tional de­bate has been about cov­er­age, specif­i­cally ex­pand­ing Med- icaid to larger seg­ments of the pop­u­la­tion, but that can’t be the only fo­cus. If we sim­ply add more Amer­i­cans to the ranks of the in­sured, we’ll make the sys­tem even more un­sus­tain­able. We need to find ways to bring costs down, re­gard­less of how we pay for them. States have shown a lot of creativ­ity, as lab­o­ra­to­ries of democ­racy, to de­sign health­care re­form ini­tia­tives that suit the unique needs of the peo­ple they serve.

A re­port pre­pared for NGA, with gen­er­ous sup­port from the Com­mon­wealth Fund and oth­ers, sug­gests five key ar­eas for state­based re­form:

Qual­ity im­prove­ment: Ul­ti­mately, this is what it’s all about. We need to en­sure that all Amer­i­cans re­ceive the care they need when they need it. A study con­cluded that one doc­tor in six or­dered a test that had al­ready been done, and one in four pro­vided treat­ment that was un­nec­es­sary. We need to de­fine qual­ity, mea­sure it, pro­vide the IT sup­port to as­sure its de­liv­ery and pay for it ap­pro­pri­ately.

Care co­or­di­na­tion and disease man­age­ment: Chronic ill­nesses ac­count for the over­whelm­ing ma­jor­ity of health­care costs. Those with a chronic disease must be iden­ti­fied and treated. Di­a­betes is the first chronic con­di­tion that some states have ad­dressed, as there’s a real op­por­tu­nity for suc­cess­ful in­ter­ven­tion and cost sav­ings.

Pri­mary care and preven­tion: We need to en­cour­age ev­ery­one to have a med­i­cal home with a team of car­ing pro­fes­sion­als to co­or­di­nate care. We must think of health­care as a strat­egy not just to in­ter­vene when some­one gets sick, but to keep peo­ple well. Fur­ther­more, many chronic dis­eases can be pre­vented or their ef­fects mit­i­gated through timely diagnosis and early in­ter­ven­tion.

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