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Health care leaders give state policymakers recommendations for improving health care
By Chris Barnett / December 23, 2014 /   Loading Disqus...

Developing a payment model that rewards patient-centric care delivery and expanding incentives for participating in a statewide health information exchange are among the recommendations that a broad coalition of insurers, hospitals and academics are asking state policymakers to consider adopting.

Convened by U.S. Sen. Sheldon Whitehouse and Rhode Island Foundation President Neil Steinberg over the past few months, the group lays out specific recommendations on payment reform, tracking metrics and more.

“Better quality of care for Rhode Islanders at a lower cost is a vital and achievable goal for our state,” said Whitehouse. “The reform goals we agreed to champion will help us move toward a system that rewards better care of patients and eliminates unnecessary and duplicative care.  These are goals that are best achieved when we all pull together, so it is important and striking that this agreement is so widespread.”

In a letter to Gov.-elect Gina Raimondo, House Speaker Nicholas Mattiello and Senate President Teresa Paiva Weed, the coalition says consensus developed around a belief that for fundamental change to occur, the state must work to alter the way health care is paid for.

“These recommendations are both practical and significant. While everyone recognizes that payment reform is crucial to ensuring we have a healthcare system that can deliver quality care over the long-term for all Rhode Islanders, consensus on how to get there is rare. One of Rhode Island’s strengths is our ability to get decision-makers together face-to-face to find common ground,” said Steinberg.

The letter notes that Rhode Island currently spends nearly $9 billion yearly on health care and calls the health care industry, businesses, consumers and state government to make changes that will make the cost of health care sustainable in the long term

The coalition’s recommendations fall into the following categories:

  1. Statewide Payment Reform Goals
  2. Statewide Progress Targets
  3. Statewide Tracking Metrics
  4. Action Steps for State Health Care Leaders and Policymakers

Establish Statewide Payment Reform Goals in 2015:

To achieve payment reform in the next five years, the health care leaders asked state policymakers to support their commitment to work together to implement payment reform and support the following statewide payment reform goals: 

  1. The expansion and development of alternative reimbursement models that reward value and patient-centric care delivery. 
  2. Expansion of incentives for systems of care that encourage collaboration and sharing of claims data and the sharing of health care information through CurrentCare, the statewide health information exchange, and other electronic health record systems.
  3. Elimination of waste in the health care system by reducing administrative overhead and encouraging the use of best practices to improve clinical outcomes while reducing costs. 

Establish Statewide Progress Targets in 2015:

As new payment models are introduced, it is important to set specific and bold targets for the State to meet. Establishing statewide targets sends the message that Rhode Island is committed to changing the traditional payment reform structure. Recommendations for progress targets include:

  1. State and health care sector leaders should set an aggressive target and timeline to reducing the traditional fee-for-service model.
  2. State policymakers and health care leaders should immediately collect the necessary data to establish a strategy to control costs and examine various options, such as linking health care inflation to Gross State Product.
  3. Some estimates suggest that up to 30 percent of health care spending could be eliminated without impacting the quality of health care. Specific targets should be established for the increased utilization of electronic medical records and reduced administrative costs. This effort will also require increased levels of consumer engagement and cooperation from patients.

Statewide Tracking Metrics:

There are several key benchmarks that can be tracked at both the national and state level to ensure that care is improving as the delivery system is transformed. There are various datasets available that can help track quality performance. HealthCentric Advisors, the state’s Quality Improvement Organization, currently works with the State and stakeholders to generate quality reports. The coalition will work with HealthCentric Advisors to identify six or seven important measures that can be tracked to ensure that care is being improved. Potential quality measures should include:

  • Healthcare Acquired Infections
  • 30 Day Readmission Rates by Hospital
  • Statewide Emergency Department Visits
  • Health Information Technology (HIT) Utilization

Recommended Action Steps for State Health Care Leaders and Policymakers:

Various state agencies and entities are independently working on this issue, but a coordinated statewide payment reform plan is needed now. The letter proposes a public-private partnership to advise on the transformation of the delivery and payment system for health care in Rhode Island with the support of health care leaders, the business community, consumers, the governor and the legislature. This partnership should:      

  1. Immediately establish a stakeholder group (providers, payers, employers and consumers) to work collaboratively with the administration to transform Rhode Island’s heath care payment system. 
  2. To the extent there are gaps, rapidly define and collect data to create a profile of health care in Rhode Island (includes quality metrics and spending statistics).
  3. Establish statewide baselines and goals for health care spending and quality for the next five years and report progress annually.
  4. Use existing health care spending programs to accelerate coordinated, risk based care.
  5. Encourage consumer engagement to increase the selection of high value care based on cost and quality data.
  6. Review and reform state healthcare regulations to promote efficiency.
  7. Promote better population health and personal responsibility in health care.

The letter is notable for both the scope of the recommendations and of the individuals and organizations who signed it.  The co-signers of the letter include Lt. Governor and Secretary of the Department of Health and Human Services-nominee Elizabeth Roberts, Lifespan President and CEO Timothy J. Babineau, Blue Cross & Blue Shield of RI President and CEO Peter Andrusckeiwiz, Care New England Health System President and CEO Dennis Keefe, United Healthcare CEO Stephen Farrell, Rhode Island Business Group Health Executive Director Al Charbonneau, and Peter Marino of Neighborhood Health Plan.

“Rhode Island is one of the states that is moving assertively to make federal healthcare reform a reality,” said Roberts.  “The payment reform and delivery system changes envisioned by our health care leaders and set forth in this compact provide a critical roadmap to a stronger Rhode Island economy and healthier Rhode Islanders.”

 “I believe Rhode Island is perfectly poised to bring the health care leaders together in order to agree to implement health care delivery improvements and provider payment reforms that will benefit Rhode Islanders,” said Speaker Mattiello.

“The Senate both supports and commends the leadership of Senator Sheldon Whitehouse and Neil Steinberg in confronting one of the greatest challenges facing our health care system,” said President of the Senate M. Teresa Paiva Weed.  “The recommended reforms build upon and are consistent with the findings of the 2011 hospital study commission led by Senator Joshua Miller and subsequent Senate legislative initiatives. We support the commitment of the stakeholders to work together to implement the payment reform goals while continuing to provide high quality health care.”

“Nothing is more important to Rhode Island’s economy and its residents than finding a way to lower healthcare costs and maintain quality.  But this is an endeavor that cannot be conducted in isolation and requires sustained effort by all the players involved in healthcare delivery.  The compact is a critical step in continuing the important efforts already underway to assure the future of affordable healthcare in Rhode Island,” said BCBSRI’s Andrusckeiwiz.

“I am very pleased that Lifespan participated in and contributed to this very important compact.  The consensus and collaboration I witnessed was encouraging.  I believe this concise document will provide a useful framework to help guide our elected officials as we all work to create new models of care and new models of payment to better serve our citizens of the region,” said Lifespan’s Babineau.

“We were honored to be part of this highly collaborative process,” said Care New England’s Keefe, “which closely aligns with our strategic vision and the national agenda to improve quality, the patient experience, and reducing the overall cost of care.”

Other signatories on the letter are Al Kurose, President & CEO of Coastal Medical; Dr. Kathleen Hittner, Health Insurance Commissioner; Peter Karczmar, President of RI Medical Society; Christina Paxson, President of Brown University; Laura Adams, President & CEO of the Rhode Island Quality Institute; Michael Fine, MD, Director of the Rhode Island Department of Health; Dr. Al Puerini, RI Primary Care Physicians Corp.; Jack Elias, Dean of Medicine at Brown University; Lou Giancola, President & CEO of South County Hospital; Secretary of Health and Human Services Steven Constantino; Lou Rice, President of University Medicine Foundation; Leonard Schindel, CharterCare; Jane Hayward, RI Health Center Association; Mike Souza, Hospital Association of RI; John Keimig, Healthcentric Advisors; and Thomas Reardon, Prospect East Holdings

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