Prior to the COVID-19 pandemic, cost, access, and equity warning signs already existed in Pennsylvania’s health care system. One in two Pennsylvanians find it hard to pay their medical bills, and the commonwealth’s health care costs have been growing annually at a rate significantly above the annual statewide growth in gross domestic product (GDP). This results in Pennsylvania families and businesses paying more each year towards health insurance premiums and out-of-pocket costs.
The Interagency Health Reform Council (IHRC), created by an executive order Governor Tom Wolf signed on October 2, 2020 to address whole person health reform, recently presented its recommendations for how to shift this reality so that payment and health care delivery systems are aligned, costs are reduced, disparities tackled, and government and corporations better address the needs of the whole person.
“The recommendations of the council present a comprehensive look at how to address the needs of all Pennsylvanians and how we can make a healthier Pennsylvania a reality,” Gov. Wolf said. “If we do not consider everything about each person – their immediate health needs, the conditions they live in, and the environment they grew up in – we are only treating a small portion of what influences their health and well-being.”
The IHRC’s Health Care Reform Recommendations include:
Creating a Health Value Commission to Institute Health Care Cost Benchmarking
Achieved via legislation, the Health Value Commission efforts could provide up to $6.4 billion in savings for Pennsylvania businesses and consumers between 2022 and 2026 by establishing and monitoring payor and provider performance toward a cost-growth benchmark. Exceeding the benchmark would require an improvement plan towards more accountability. Spending targets would also be developed to support primary care, behavioral health and value-based payments – the foundations of a well-functioning health care system.
Addressing Health Equity – defined as everyone having a fair and just opportunity to be healthier.
Regional Accountable Health Councils will be developed as forums for strategic health planning across payors, providers, and community-based organizations that will make health equity a first priority. These councils would help identify areas of profound inequities, called health equity zones. Grants and incentives to reduce disparities are part of the plan. As well, attention to communities facing trauma and to promoting culturally and linguistically sensitive services across all agencies and program and eliminate bias are recommended.
Integrating Social Services into the Delivery of Health Care
Social determinants of health greatly influence physical and mental health and can take many forms that must be addressed. The plan recommends using the recently procured RISE PA platform, a statewide resource and referral tool that when implemented will identify individuals with unmet social needs and connect them with community resources. The recommendation also includes the need to develop resources for local braiding of funding, which can mean combining federal, state, private funding streams to best support valuable programs and not lead to disjointed or fragmented social services delivery.
Driving Quality Improvement – making data dashboards public-facing and inclusive of metrics and quality improvement incentives
Measure the quality of care and aligning those measures are vital to making people healthier. Recommendations include measuring quality including in opioid use disorder treatment, long-term services and supports, and in aligning physical and behavioral health measures across state agencies. The recommendation also includes maintaining telehealth access.
Align Value-Based Purchasing (VBP)
Paying for value means that providers are rewarded for delivering high-quality care and reducing total costs. The recommendation includes aligning terminology, reporting and VBP models across payors such as maternity care bundled payments to lower maternal mortality rates and costs, and ensuring access to data to allow providers to manage population health.
Leveraging State Purchasing Power to Achieve Savings
This includes amending pharmacy drug rebate statutes to increase rebates, and leveraging purchasing power for durable medical equipment (DME) savings, especially for DME that is used by multiple state agencies.
Streamlining Access to Medicaid to Reduce Recidivism
State savings can be increased significantly by billing Medicaid when inmates are released from state correctional facilities, potentially saving the Dept, of Corrections $2.1 million annually. As well, expanding the automation of Medicaid suspension and opening, including in county facilities, can add to savings as can tracking health care use of individuals as they reenter their communities.
Leverage Data-sharing and Health-information Exchange
The IHRC recommends determining a solution for data sharing between agencies and increasing provider participation requirements in a health information exchange, as well as an exchange alerting when services are occurring across states.
The IHRC’s next steps are to identify a timeline for implementation of recommendations and to receive feedback on recommendations via a resource account ([email protected]) for written comments on the plan that it hopes will inform implementation and guide workstreams.
The council will work with legislature on areas that require legislative action and will continue to facilitate alignment across agencies and monitor progress on recommendations.
Members of the IHRC include Meg Snead, Secretary of Policy and Planning for the Office of the Governor; Teresa Miller, Secretary of the Department of Human Services; Dr. Rachel Levine, Secretary of the Department of Health; Jessica Altman, Commissioner of the Pennsylvania Insurance Department; John Wetzel, Secretary of the Department of Corrections; Robert Torres, Secretary of the Department of Aging; Jennifer Smith, Secretary of the Department of Drug and Alcohol Programs; and IHRC Chairperson, Alison Beam, Deputy Chief of Staff, Office of the Governor.