Ohio Health Quality Improvement Plan

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Appendix IV — Co m m e n t s f r o mStatewide Or g a n iz a t io n svaluable learning experience as we each continue to striveto understand the challenges being faced by all stakeholdersin the health care system.OAHP hopes we are afforded an opportunity to continueour involvement with the newly formed Health careCost and Quality Council and the development of theimplementation details for the four core strategies. Wewould like to ensure there is a focus on achievable resultsand a process that captures work being done at the nationallevel in many of these areas. In fact, leaders from ourindustry are initiating efforts on consumer engagement,electronic technology, payment strategies and medicalhome pilots across the country. We look forward to briningour expertise on these issues.For the health insurance industry, we are particularlyinterested in the efforts concerning payment reform,engaging the consumer and the development of patientcentered medical homes. In looking for a top priority, Ithink the council will be confronted with a chicken andegg scenario. Do you fix the problems with the currenthealth care system and follow-up with payment reforms toreward the changes or do you reform the payment structurein hopes of achieving the changes needed to transform thehealth care system? I think this will be a major focus andpotential struggle for the Council.In reviewing the CORE strategies there are opportunitiesfor integration. For example, I believe payment reformcan have an impact on the patient centered medical homedevelopment which also references development ofpayment reforms. In all of these areas, it will be importantto avoid duplication of efforts.Finally I have comments on the draft report and area forfuture consideration. In the area of activated patientsand individuals, there appears to be lacking a tactic toprovide information to consumers on costs or outcomes ofmedical providers and facilities or to educate consumerson their rights and responsibilities as a patient and userof the health care system. I believe this would round outthe area of activated patients and individuals. In the areaof payment reform, it will be important for this groupto look at payments within the entire system and findways to address the subsidy that is being imposed in thecommercial insurance market by medical providers tocover the inadequate payments from government programs.36Additionally, I would caution against implementationof payment reforms by regulations. Any paymentmodels recommended by the council should be basedupon proven results from pilots or other efforts alreadyunderway in Ohio or other states. There should also beagreement that payment reform involves realigning thecurrent dollars available for medical services based uponoutcomes and “what we want to achieve” from the system.Acknowledgment of this will be needed to achieve successin any payment reform discussion.Ohio Business RoundtableThe Ohio Business Roundtable is thankful for theopportunity we were given to participate in Ohio’s HealthQuality Improvement initiative, and we commend the workof the core and implementation teams for their work indeveloping the Ohio Health Quality Improvement Plan.We share a sense of ownership with the plan’s other cocreators,and we believe the plan takes a comprehensiveand holistic approach to reforming our health care systemwhile also identifying four key and appropriate initialpriorities for focusing Ohio’s health reform efforts.Our attention – and, we hope, the attention of the plan’sother co-creators – now shifts from diagnosing andprioritizing health care reform priorities to the much harderwork of implementing solutions. The creation of the OhioHealth Care and Coverage Council is a good start forcoordinating implementation-focused reform efforts, andwe strongly urge lawmakers to invest the modest resourcesneeded to fund the Council and its staff that were requestedin the Governor’s proposed budget so that this muchneededwork can move forward.To maximize its potential for success, we urge the Councilto maintain a disciplined focus on the initial prioritiesidentified in the draft plan. These priorities align well withthose identified in our recently released Improving Ohio’sHealth System diagnostic report (see, for example, thepopulation health, chronic disease management, consumervalue consciousness, provider value consciousness,and technology-enabled clinical information sharingopportunities discussed on pages 9, 40-47, 53-58, 76-79,and 90-92 of the report) . There have been and will bemany temptations to take on everything when tacklinghealth care reform. Maintaining focus on the plan’spriorities will help combat these temptations – and, infact, the Council should consider even further focusing
Appendix IV — Co m m e n t s f r o mStatewide Or g a n iz a t io n sinitial efforts on tactics within two of the strategies thatwe believe offer the most immediate opportunities fortransforming our system. Those two strategies are (1)payment reform, including moving away from fee-forservicereimbursement and towards a more comprehensive,risk-adjusted payment system that incentivizes health careproviders to reduce the highly fragmented nature of ourcurrent delivery system (through, for example, accountablecare organizations or other vertically integrated modelsthat include medical homes to coordinate care, especiallyamong patients with multiple chronic conditions), and (2)catalyzing more rapid adoption of electronic health recordsas part of integrated health information systems.The Ohio Business Roundtable stands ready to commitits time, talent, and resources to ensure the success ofthe Council and the plan – and we hope our partnersin developing the plan will continue to invest theirfull energies toward the common vision and principlesidentified in the plan for transforming Ohio’s health system.Ohio Chamber of CommercePatient Centered Medical HomesA Patient Centered Medical Homes (PCMH) model issomething that Ohio should strive to adopt. Encouragingpatients to develop a continuous relationship with a healthcare provider can enhance patient care and help ensurequality of care and reduce cost in the system. Employersshould be considered an integral part of the PCMH Taskforce in order to encourage the widespread use of PCMHsin our current employer based health care system. Toensure that the adoption of PCMH does not simply layeradditional cost on the system, the state should be mindfulthat a PCMH does not necessarily need to be a physician,other health care providers may be a more appropriatehome for coordination of care and other functions ofa PCMH. Also, adoption of a PCMH model does notnecessarily equate to more physicians; in fact a wellrespected research group The Dartmouth Institute forHealth Policy and Clinical Practice just commented on thisvery issue. At this early stage, it seems appropriate that thestate could first implement this approach with the Medicaidpopulation, which amounts to about 13 percent of Ohioansand focus the PCMH approach on those with chronicconditions first.Health Information TechnologyHealth Information Technology (HIT) is going to benecessary if Ohio is going to move forward in reformingour health care system. There have been many advances inthe area of HIT in the past few years. A number of payershave adopted or are in the process of adopting IT systemsthat can process claims quicker and more efficiently, allowpatients access to claims on-line and use electronic tools tohelp educate patients about disease prevention and chroniccare management. While at the same time, providers arebeginning to utilize other technological advances suchas e-prescribing and personal health records to advancecontinuity and quality of care. Large providers especially,have taken a leading role in the adoption of technology topromote optimal care. But smaller, individual provideroffices are lagging behind in the adoption of suchtechnology that will be necessary to implement several ofthe strategies laid out in this proposal including PCMHs.Further, the state should take care not to duplicate effortstaking place by the private sector. A number of productsare available on the market and while the state should spareno effort to encourage the use of HIT, it should not becompeting with private sector products.Payment ReformArguably the most discussed of the four reform strategies,payment reform, though necessary, is not the silver bulletfor fixing our health care system, but rather a means toachieve the necessary reforms. Through payment reforms,the state can achieve quicker adoption of PCMHs and HIT,but payment reform alone will not address the staggeringincreases in the cost of health care. Payments should focuson “episodes of care” rather than payments for individualservices. In addition, it seems appropriate for the state towork in conjunction with health care providers to developbest practices that include standards of care for commonepisodes or procedures, similar to the Geisinger HealthSystem’s ProvenCare program in Pennsylvania.Informed and Activated Patients and IndividualsInformed and active individuals are a critical piece ofthe health care reform puzzle, without such individuals itwould be virtually impossible to reform our health caresystem. In moving to ensure that all individuals becomeinformed and activated, the state must ensure that there isfocus on transparency in all aspects of the care continuum,including incentives for compliance and penalties for noncompliance.37
Page 1 and 2: Ohio Health QualityImprovement Plan
Page 3 and 4: Introduc tionIn November 2008, more
Page 5 and 6: In t r o d u c t io nimplementation
Page 7 and 8: Oh io He a l t h Qu a l it y Im p r
Page 9 and 10: Pa t ie n t Centered Me d ic a l Ho
Page 11 and 12: Pa t ie n t Centered Me d ic a l Ho
Page 13 and 14: He a l t h In f o r m a t io n Te c
Page 15 and 16: Pa y m e n t Re f o r m◦◦◦◦
Page 17 and 18: In f o r m e d a n d ActivatedPa t
Page 23 and 24: Me a s u r in g Su c c e s sPropose
Page 25 and 26: Ne x t StepsOhio Health Care Covera
Page 27 and 28: Appendix II — Response to Questio
Page 29 and 30: Appendix III — Su r v e y Results
Page 31 and 32: Appendix IV — Co m m e n t s f r
Page 35: Appendix IV — Co m m e n t s f r
Page 45: CORE PLANNING TEAMAmy Rohling McGee

Ohio Health Quality Improvement Plan

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