None of three current proposals can help Minnesota without the others.
There are now three proposals, outlined by Minnesota's leaders, meant to chart the course for the future of health care in the state. There is good in each, but none can stand alone to improve on the current system and save $1.6 billion for the next biennium.
Positions are hardening and the road ahead is uncertain, but there remains an opportunity to solve this complex problem in a way that creates a bridge to a healthier and more economically stable future. With the willingness to compromise comes the potential for meaningful reform.
Throughout Minnesota, caregivers have a responsibility to our patients to play a leadership role in helping lawmakers chart a path that moves Minnesota forward. In that spirit, I offer the following recommendations -- drawn from proposals provided by the governor, the House and the Senate:
1) Preserve coverage: We all win when the less fortunate have access to care. The alternative is a system in which the uninsured are forced to use hospital emergency departments for primary-care services.
The community cannot continue absorbing these costs; the losses are underwritten by employers, private insurance and our hospitals. Higher rates of uninsured and uncompensated care lead to poorer health outcomes for our fellow Minnesotans, and the presence of a large group of uninsured citizens leaves us with little ability to manage their care more efficiently.
2) Increase patient responsibility: We must move beyond a system of care that allows individuals to ignore responsibility for their own health. Targeted incentives that reduce utilization of inappropriate services, increase primary care utilization and decrease tobacco use and obesity are powerful arrows that we need in our quiver. Raising tobacco taxes is one example.
3) Pay caregivers for outcomes: Through work done in Minnesota, we know incentives can change the way care is delivered, unlocking innovation to improve quality, access and reduce costs. A system that pays caregivers to keep a person or population well rather than one that rewards only direct patient care holds real promise for improved outcomes.
4) Allow flexibility: Not every caregiver or hospital in the state can take on the significant financial risk of an assigned Medicaid population. If we want to maintain the economic health and stability of our rural hospitals and providers, they should be allowed to remain in a fee-for-service payment environment. They are simply too small or see too few patients to take on insurance risk.
5) Reduce administrative costs for Medicaid programs: The state does not possess the systems needed to manage a high-risk population. Eligibility systems, claims processing and related services should be outsourced to the private insurance industry.
Contrary to popular belief, Minnesota boasts some of the nation's best health plans. They operate with modern systems and direct more dollars to patient care as an overall percentage of premiums than do the vast majority of health plans operating in this country. Through outsourcing and competitive bidding, we can greatly reduce the costs of Medicaid plan administration.
6) Empower caregivers and patients: There is a significant opportunity to eliminate regulatory, legal and administrative burdens that drive a wedge between patients and their caregivers. With all of the talk about health care reform, it is reform of health care financing that has been the center of the debate. We should focus efforts on improving the access and connection of patients to caregivers.
7) Pursue a waiver from federal health care reform: Minnesota has a long tradition of leading the nation in health care. We produce leading health outcomes at very low cost relative to other states.
By building a health care model for Minnesota that meets the same access, quality and affordability benchmarks as federal reform but does so in the Minnesota way, we can reduce complexity and send a message to our community that we have their best interests at heart.
The "art of the deal" sometimes means seeking a compromise of ideas but rarely a compromise of ideals. By taking the best thinking from each current proposal, we have the potential for a real breakthrough.
Kenneth H. Paulus is president and chief executive officer of Allina Hospitals & Clinics.
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