HealthPartners health care reform principles
Health Care Transformation through Healthy Public Policy
Revised May 2008
HealthPartners is committed to transforming health care and financing into a system that can achieve the “Triple Aim;” simultaneously optimizing good health, patient experience and a reduction in per capita costs of care. We believe the health care system should be safe, timely, efficient, effective, equitable and patient-centered; we call that six aims for health care.
The Institute of Medicine (IOM) challenged health care stakeholders to transform care systems in its groundbreaking report, “Crossing the Quality Chasm: A New Health System for the 21st Century.” Our platform of principles for health care reform is based on the report’s six aims, which form the basis for our work in improving the health of our members, our patients and our community.
1. HealthPartners will transform the health care system by initiating and supporting policy initiatives that are based on the six aims: Health care that is:
Patient centered reform means that the health care system is responsive to the needs and desires of patients and is equipped to address individual differences. This aim is integrally tied to the other five aims. It also means that consumers of health care have a personal investment in their health and will expect services individually tailored to help them maintain and improve their health.
Equitable care means that health care is affordable and accessible for all, and that our health care system is designed to reduce disparities across populations and communities.
Timely, effective and efficient care means that the right care is delivered at the right time in the right setting. Payment systems are redesigned to promote performance and delivery of care based on best practices established by the Institute for Clinical Systems Improvement (ICSI). ICSI is an independent nonprofit organization that provides quality improvement services to 45 medical organizations, representing 6000 physicians.
Health care reform must also address the consumer value equation, balancing what consumers need with what they want. Providing consumers with relevant information about quality, cost and choices in health care is vitally important.
Safe means our first commitment is to do no harm. Consumers should expect that care is delivered based on the best science and safety practices. These practices are rigorous, standardized and that performance is public.
To achieve this end, we will work both locally and nationally to act as a catalyst for change in the health care system.
- HealthPartners will actively participate in national and state forums to advocate for these changes and share with others the ways in which we are working to achieve that in our care delivery and health plan activities.
- We will engage federal and state policy makers, regulators, business leaders, providers and other opinion leaders in advancing this platform.
2. Every Minnesotan should have health care coverage and that coverage should be affordable.
We believe that every individual should have access to health care services, and that the best means of providing that access is through a requirement that everyone has insurance coverage.
Health coverage is fundamental in reducing health care disparities and improving the health of the community. The evidence is compelling that health insurance reduces mortality rates by 10-15 percent. Educational attainment and annual earnings increase significantly with health care access. Uninsured individuals are more likely to be hospitalized because pre-hospital care is both too little and too late.
Today the costs for caring for the uninsured are hidden in the higher payments made by people with private insurance coverage. From a financing perspective, only through universal coverage can we guarantee that people both healthy and sick participate in the funding of health care, creating a broad, sustainable community risk pool.
HealthPartners advocates achieving coverage for all through a combination of the current, voluntary employer-sponsored system, and an individual insurance requirement or mandate (for a base level of coverage), to be purchased through employers or on the individual market, as the most feasible reform leading toward universal coverage. This also builds on the strong state and federal programs that subsidize persons who participate in Medicaid, MinnesotaCare, General Assistance Medical Care and Medicare.
Universal coverage is sometimes associated with a single payer, or the federal government purchasing and administering the health care system. HealthPartners advocates for universal coverage, with the role of government as a market facilitator rather than administrator. Government also ensures that individuals who can’t afford insurance and meet special eligibility requirements are subsidized in public sector programs. The intersection of government programs and private insurance is an important consideration to ensure that we minimize incentives for private employers to drop insurance coverage.
For individual mandates to work effectively, the following must occur:
- Minnesota must determine a base level of coverage that all Minnesotans are required to carry.
- The existing marketplace (group and individual) should be encouraged to bring products to market that meet the coverage requirements in the most affordable design.
- For every individual to have coverage, health plans will need to provide coverage regardless of an individual’s health status (guaranteed issue).
- It must be easy for individuals to purchase insurance products. Special assistance will be needed for individuals who need help with understanding health coverage and making choices.
- To spread the costs of coverage in a way that is fair and which creates the largest possible community pool, a risk adjustment mechanism will be required.
- Subsidies currently in the individual market (fully insured employers subsidize this market $100 million annually) and the role of Minnesota Comprehensive Health Association need consideration in the transition to a guaranteed issue market environment.
- Coverage for individuals should be portable, following individuals from employer to employer, and be adjustable, based on their life stage and needs
- Federal and state tax laws should allow individuals to receive the same benefit for purchasing individual insurance as exists for groups.
- There must be an enforcement mechanism, such as proof of insurance when filing tax returns (revised form for verification). Enforcement must be real or the individual market will not function well.
Government Programs Reform
Individuals who qualify for state or federal public programs should be able to access and enroll in those programs without barriers. The application process should be simplified and government agencies should be held accountable for results.
At the federal level, Medicare reform needs to include the following components:
- Ensure choices for seniors to enroll in Medicare product options. The Medicare Cost Contract policy provisions to ensure choice and extension should be a top priority, given the 80,000 MN seniors enrolled in Medicare Cost plans.
- Federal health policy should support integration between Medicare and Medicaid for individuals with complex special needs, and allow appropriate new Special Needs Plans to serve high risk populations.
- The Medicare program needs to ensure that prescription drugs remain affordable and needs the ability to negotiate Rx pricing with pharmaceutical companies.
- Regional inequities in Medicare payments offer higher rates in regions of the country with the highest costs and worst quality. Those incentives and inequities should be eliminated.
- Physicians, hospitals and plans should be incented by Medicare for improvements in quality and efficiency.
Affordability is the key to achieving universal coverage. Whether funded through employers, out of pocket, or through taxes, the high costs of health care today must be addressed.
3. Purchasers (government and plans) should pay for performance – quality and results.
The current health care payment system encourages volume, production, procedures, and technology use instead of health and health improvement. We must align financial incentives with our goals – population health, patient experience, reduction in the cost of care – if we are serious about achieving them.
HealthPartners strongly advocates redesigning payment systems to reward outcomes rather than the current methods that are based on volume and production. Payment reform is necessary to remove barriers to transforming the health care system and should support high quality affordable patient centered care and outcomes. We will work with consumers, government and health care providers to create a system that demands the best value in health care. This requires the following actions:
- The government and private sector should establish the performance measures together, working with the Institute for Clinical Systems Integration (ICSI) and Minnesota Community Measurement.
- Minnesota Community Measurement is the Minnesota "Value Exchange" for transparency of results and setting the measures for pay for performance across the state.
- The federal government should grant states the flexibility to define the targeted measurements and rewards for Medicaid and Medicare, e.g. to promote alignment with Minnesota quality objectives and reporting standards.
- Measures must focus on evidence, based on the community standards. We may need to include process measures that lead to best practices, in areas where the scientific evidence is less developed.
- Payers and purchasers should use the same measures when developing performance based payment incentives.
- New models of payment that encourage providers to accept greater accountability for the cost and outcomes of the care their patients receive should be encouraged (health care home). Payment models that support these aims include modified fee for service and bundled payment methods ranging from package payment for an episode to total cost of care payments.
- We will help build payment reform models that offer better support for primary care and behavioral health care services, recognizing that care coordination is an important aspect of a high performing health care system.
- We will create and build collaborative approaches for clinical information exchange to improve health, efficiencies and safety through the Minnesota Health Information Exchange. (MNHIE)
4. Both the State and Federal Governments should align with private sector initiatives to require transparency and accountability in performance – quality and results. The performance of medical groups, hospitals, and health plans in achieving quality (six aims) should be publicly available from a single, credible source. Transparency in the health care system is fundamental to a system that is redesigned to reward quality and health care outcomes. Transparency from a consumer perspective means that consumers can use relevant information about the total costs of care, safety, quality of care, and patient/member satisfaction when making a health care decision.
Steps to achieve a goal of true transparency in the system must include:
- Minnesota Community Measurement as the single source for community reporting on medical group performance. As the reporting source, MNCM should be accountable for ensuring that all measures are consistent across the organizations (health plans, state purchasers such as the Department of Human Services and State Employees Group Insurance Plan, hospitals, medical groups). The long term goal should be to develop provider-specific quality reporting data that can be made available to the public.
- Comparative quality measures for specialty care must be developed and publicly reported.
- State quality measures (aligned with national standards) for health plan quality (Evalu8, NCQA, HEDIS) reported publicly through MN Community Measurement
- Establishing quality improvement projects for state public programs aligned with identified statewide priorities to improve health.
- Making financial arrangements between pharmaceutical manufacturers, medical supply and device manufacturers, health plans and providers transparent to help avoid potential conflicts of interest.
- Creating standardized reporting offering consumers meaningful comparisons on total costs of care and cost comparisons by providers. This needs to include prescription drugs.
- Efforts to reduce errors and curb the spread of dangerous diseases, such as Methicillin-resistant Staphylococcus aureus (MRSA), should be based on the best national approaches as developed by experts from groups like the National Quality Forum(NQF), the Institute of Medicine (IOM) and the Centers for Disease Control (CDC).
5. Regulations should focus on providing choices for consumers and employers and protecting consumers by assuring the financial viability of our non-profit health care system. All parties should work together to eliminate administrative waste in the health care system.
The government’s role in the health care system should focus on market facilitation, assuring that all have access to high quality and affordable health care services. Federal, state, and local levels of government roles need to be clearly articulated, and areas of conflict and overlap eliminated. State regulations should be modernized. Government needs to be responsive, efficient, and ensure that regulations add value to the consumer.
Everyone in the health care system has a role to play in simplifying administrative functions so that they work as efficiently as possible and add value. To these ends, HealthPartners advocates:
- Elimination of duplicate authority and regulatory reporting to multiple government agencies. Consolidation of all health care regulatory activities into one state agency.
- Fair competition would help in the regulatory framework for the marketplace and product flexibility to meet consumer and employer needs.
- Reducing administrative costs across the system.
- Standardized administrative functions between health plans and provider billing, eligibility and remittance. Participate actively in the development of these standards through the Administrative Uniformity Committee (AUC)
- Redesigning benefit plan requirements to conform to basic designs recommended by a key expert panel.
- Reviewing Minnesota’s mandated benefits based on comparative clinical effectiveness and efficiency. New proposed mandated benefits should undergo a comparative clinical effectiveness analysis before being acted on by the Legislature.
- Ongoing rigorous support for Minnesota’s non-profit health care structures to ensure community benefits rather than shareholder benefits.
- At the federal level, creating a mechanism for the FDA to approve generic versions of biologic pharmaceuticals and opposing direct to consumer advertising for new drugs in the first two years after introduction.
- Consolidation in our health care market should be scrutinized to assure that no entity (plan or provider) violates anti-trust laws and that consolidation results in increased efficiency not just increased costs.
- Creating workforce solutions that help resolve critical shortages (e.g. recognize appropriate scope of practice changes and following the nursing compact in Minnesota).
- Reporting the costs and benefits of regulation so that they are transparent for consumers.
- Ensuring choice in health plan options for persons covered by state public programs on a county level, rather than allowing sole source purchasing for the State of MN Medical Assistance program.
6. State policy should encourage healthy lifestyles and support health promotion.
The best way to reduce the increases in health care costs is to improve the health of our citizens. While there is broad agreement that better health and health improvement are necessary to improve our system, public policy to invest in health is a critical component. HealthPartners will actively support policies that promote public health and healthy lifestyles.
- An increase in the state tobacco tax (or health impact fee)
- Maintaining the Freedom to Breathe achievements in preventing exposure to second hand smoke
- Promote healthy pregnancies
- Physical education requirements at each grade level for high school graduation
- Health education at each grade level on healthy lifestyles
- Healthy planning for cities (active living programs)
- Healthy menus for children enrolled in licensed daycares, pre-schools, and schools.
HealthPartners will advocate for the adoption and funding of the Department of Health Comprehensive Statewide Health Promotion Plan.
7. The state should lead development of public health goals, and the role of the public health system, and work in partnership with the private sector to improve public health.
The government plays a vital role as a policy maker, purchaser and service provider of essential public health services, and the private sector plays a complementary and important role. The fundamental role of government is to promote and protect the health of the public, but it does so increasingly in collaboration with the private sector. The private sector can be broadly defined to include purchasers, health plans, hospitals, health care providers, media, businesses and other nonprofit service organizations.
The overall success of our member and community initiatives to improve health is directly tied to the strength of our public health system. Government must fund those health services that are more efficiently and effectively delivered in the public health system, and that strengthen its ability to carry out the core functions of surveillance and protection of the public’s health. HealthPartners will advocate for recommendations in the Institute of Medicine Report, The Future of the Public’s Health in the 21st Century to create a national dialogue on public health policy forum. This group would have responsibility to design the future infrastructure and access improvements for essential public health services. Some specific approaches to achieve the principles are:
- Working through schools and promote funding for school health services to assume responsibility for select public health services. Another key strategy is to ensure schools offer physical activity and healthy meals to all Minnesota students.
- School health programs should also be adequately funded to help coordinate care for children with special health care needs and chronic medical conditions.
- Identifying and funding those services most effectively delivered in the public health sector, assuring a strong public health infrastructure. For example, ensuring that Title V is continued to be fully funded to provide services for women and children in Minnesota.
- State participation in the Minnesota Health Information Exchange, for clinical data exchange to improve health and safety.
- Allocating government resources to create and maintain statewide immunization registry.
- Align initiatives in the clinical setting, health plans and with community and government agencies to address the prevention of obesity, diabetes, cancer and other chronic diseases (e.g. Minnesota Cancer Alliance, American Lung Association, and the MN Asthma Coalition).
- The state should lead in setting statewide goals to reduce health disparities and encouraging health care providers and public health agencies to measure and plan disparities interventions.
8. Minnesota deserves a mental health delivery system that encourages prevention/early detection and seamless coordination across the continuum of care.
- Models that integrate funding across multiple state agencies for the integration of physical and mental health services should be adopted.
- The state should protect the behavioral health safety net for behavioral health through adequate funding of government programs, reducing barriers to eligibility and addressing capacity issues in the community. Critical access hospitals, clinics and other providers should be considered as a new designation for payment.
- The state should invest in more supportive housing options and intermediate levels of care for persons with mental illness an alternative to more costly inpatient care.
- Grant programs that target communities for crisis services and primary care access need to be preserved.
- Workforce capacity should be addressed through scope of practice changes for advanced practice nurses, and cooperative agreements with psychiatrists, and through the provision of funding for increased training for primary care providers on the diagnosis, treatment, and care coordination of mental health.
- The state should support payment reform initiatives to support the provision of mental health services in the primary care settings through demonstrations such as the Diamond Project.