Health care reform is perhaps the most important and difficult domestic issue in state and national politics right now. Health care costs continue to escalate, and the individual insurance market struggles as Congress has been unable to replace or improve the Affordable Care Act.
In my position as chairman of the Intermountain Healthcare board of trustees, I wish to share some reforms suggested by Utah's largest health care provider. Intermountain has been recognized as a model of health care innovation with its comprehensive, interdisciplinary approach to patient care. These are recommendations from the doctors, nurses, hospital administrators and insurance professionals who are on the front lines, providing health care services to thousands of patients each day, at a cost that is among the lowest in the nation.
These eight reform opportunities could improve health care delivery and make it more affordable.
States are best positioned to determine the health care needs of their citizens, and they need flexibility to structure and administer the Medicaid program. Federal funding should be sufficient to sustain the Medicaid Accountable Care Organization program, including future enrollment growth. Low-cost states and those that did not expand Medicaid should not be penalized. Block grants should provide per-capita payments to all states.
States should be allowed to include additional "targeted" recipients, such as childless adults, and also allowed to cover generic drug equivalents and take measures to control medication costs.
Many physical illnesses are related to mental and behavioral health. A holistic approach to patient care that gives caregivers tools to identify mental, emotional and behavioral health issues will improve outcomes.
Intermountain's 20-year-old Mental Health Integration Program has demonstrably improved care and reduced costs (achieving a cost savings of $115 on an investment of $22 per patient per year) for commercially insured patients. However, payment structures make it difficult to extend the program to patients covered by Medicaid.
Patients have the right to have their wishes known and followed at the end of life. The too-common circumstance where family members and caregivers are compelled to insert their own judgment into this critical decision should be avoided.
The state should work with other groups to create a statewide database containing people's wishes and make it available to emergency medical personnel, hospitals and emergency rooms. Evidence shows that most people choose a medically conservative approach for themselves. This saves money but, more importantly, gives people their own voice in their care.
People with severe chronic diseases frequently have distinct, and predictable, health care needs and associated high costs better addressed with an insurance product designed specifically for them. Doing so has the potential to dramatically lower premiums for the rest of the population, removing the most significant factor that discourages healthier people from purchasing insurance.
With more than half of health care expenses being consumed by less than 10 percent of the population, this may represent the single greatest opportunity to stabilize insurance markets and lower overall health costs. The state should explore ways to partner with the federal government to fund an effective high-risk pool to stabilize and improve the private insurance market and provide better and more cost-effective care for the most medically vulnerable people.
Health care costs can be reduced and people's lives improved by supporting health needs "upstream" of intensive and expensive care. PCNs should be made available to low-income adults under 100 percent of the federal poverty level. This would be a relatively cost-effective way to meet people's needs if full coverage cannot be provided for this group.
People should never undergo treatments that are not reliably beneficial. The state should formally adopt and promote choosing wisely as a tool to educate and encourage physicians to ensure their treatment decisions are based on the best available science, and to reduce procedures that have costs and risks that outweigh potential benefits. For example, studies have shown that stents have been placed, unnecessarily, in the coronary arteries of 500,000 patients per year.
These costs are an increasing problem for consumers, providers, employers and payers. State and federal governments can take actions to begin to mitigate these rapidly increasing costs through greater transparency, increased competition and appropriate oversight and enforcement of existing laws and regulations.
As consumers pay a larger portion of their health care expenses, they seek reliable information about costs and easy access to lower-cost care options. New tools, such as the medical cost estimator, should be used to help consumers compare costs for common services. Policymakers, businesses and community leaders should promote awareness and use of consumer tools and lower-cost options by including them in health benefit plans.