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Building State-Based High Performing Systems of Care. Strengths and Threats Christopher F. Koller Health Insurance Commissioner: State of Rhode Island Alliance for Health Reform and Commonwealth Fund Briefing on State Scorecard June 15, 2007.
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Building State-Based HighPerforming Systems of Care Strengths and Threats Christopher F. Koller Health Insurance Commissioner: State of Rhode Island Alliance for Health Reform and Commonwealth Fund Briefing on State Scorecard June 15, 2007
Characteristics of High Performing Systems of Care(Commission on High Performing Health System) • Organize System for Care Coordination and Access • Promote Health Information Technology • Pursue Excellence in Quality • Produce Transparency of Price & Quality and Reward It • Increase Number of People with Health Insurance • Promote Workforce for Primary Care and Innovations • Develop Leadership and Collaboration – Cross Sectors
Elements in Place in Rhode Island • Insurance Access: • Steady expansion of Rite Care • Leveraging SCHIP • State Led Emphasis on Quality • NCQA Certified Health Plans • Rite Care purchasing and evaluation • Public Reporting by Providers • Public Immunization Programs • Leadership and Collaboration • “Line of Sight Trust”
Threats to System in RI 1. Erosion of Employer Based Health Insurance:
Threats to System in RI (cont’d) 2. Medicaid Budget - could consume 100% of every new dollar in next 5 years - Spending is in elderly and disabled political challenge. 3. Primary Care infrastructure - Only part of system where increased dollars = improved quality and efficiency - Medicare payment system at core of underpayment 4. Chronic Care - Poor management of chronically ill population. - No investment in prevention.
What’s Needed? Help from DC to Make States Better • Fund Prevention – CDC and NIH • Set the bar high – measurement and comparison. • Medicare Innovation • CMS leads commercial payers in P4P and DRGs. • Primary Care Payment changes needed. • Facilitated Collaboration among stakeholders • Performance measurement and payment reform • Promote efforts to increase health insurance access.