Leaders have opportunity to design own reform
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.