Improving health care outcomes at an affordable cost – a case for transparency

February 26 01:00 2015 by ushadmin

Ohio is one of 11 states to be awarded a “State Innovation Model” grant to transform the way we pay for and deliver health care services. With a $75 million award from the federal Centers for Medicare and Medicaid Services’ Innovation Center, payment for health care services in Ohio will shift to a model that rewards better outcomes of care at lower costs instead of just paying for the tests, treatments and hospitalizations that are prescribed.

The change is long overdue. In our current model of payment, which pays only for services rendered, Ohioans have gotten what we’ve paid for: high health care costs without improved health. Only 10 states have higher per-capita costs and poorer overall health than Ohio, a recent Health Policy Institute of Ohio report found. These are longstanding problems for purchasers, patients and the health of our economy.

In Ohio’s new model, payments to primary care physicians will be based on achievement on measurable goals of health care quality and reductions in total costs of care for their patients collectively. For certain procedures, physicians will be paid a set fee for services they provide from pre-procedure consultation through recovery, and they will share any savings that result from better outcomes and fewer complications. On the health care delivery side, Ohio committed to ensure more evidence-based preventive services, to coordinate care for those who need it most and to reduce waste.

Ohio’s goals to get more value — more return on our health care dollar — are audacious: Gov. John Kasich aims for more than 80 percent of all Ohioans to be covered by “value-based” insurance programs in patient-centered delivery systems in the next five years. The state is backing its plan by using its own power as a purchaser of health care services for more than 2.8 million Ohioans, including those with Medicaid insurance and state employees and their dependents.

Moreover, it already has exercised that power to win commitments from the state’s largest health insurance companies, which have agreed to implement these payment and delivery system changes for their enrollees.

As leaders of Health Action Council Ohio, we represent the health-care purchasing power of public- and private-sector companies that buy care for approximately 1.8 million employees and dependents, and we support Ohio’s plan.

Most of our members are large “self-insured” employers committed to providing health benefits for their employees. We know that happy and healthy employees are vital to a productive workforce, but few of us understand the return on our investments in health care insurance coverage. Do our employees receive the best evidence-based care? Do those who have medical conditions with potentially serious and expensive implications achieve the best possible outcomes? How and where can we make better investments in the health of our employees?

The success of Ohio’s plan and the return on its investment — our investments, as taxpayers and employers — will require that we have the information we need to make better health care decisions. The time has come to ensure transparency, to enable us to compare health care quality and outcomes through public reporting across the region’s clinical practices and hospitals. Like its ratings in cost and health, Ohio recently earned a “D” in transparency of quality reporting from the national Healthcare Incentives Improvement Institute. Ohio’s notable exceptions are in the southwest and northeast regions of the state, where the Health Collaborative of Greater Cincinnati and Better Health Greater Cleveland lead public reporting activities.

Better Health, Northeast Ohio’s nonprofit partnership of stakeholders in health and health care, is a national leader in care transformation and public reporting. In more than seven years of reporting on primary care for important chronic conditions, Better Health has documented that transparency motivates improvement and provides a vital yardstick that benefits our employees and others in the region.

The federal government’s $75 million commitment to Ohio’s plan is an exciting opportunity for all Ohioans who have invested so much for so long in the health of our employees, families and neighbors. We must use all the tools we have at hand to ensure that Gov. Kasich succeeds, by insisting that the results of our investments are regularly reported to the public.

Patty Starr is the executive director of the Health Action Council and Health Quality Forum and a member of the Better Health Greater Cleveland Board of Directors. Dr. Tim F. Kowalski is president of the Health Action Council’s Health Quality Forum.