How do you transform an entire health care system? First, you need a plan.
Now online for public comment: Rhode Island's State Health Care Implementation Plan (SHIP), a federally supported effort to help the state chart a course "...from unorganized care paid on a volume basis to a coordinated system supported by payment rooted in value," according to the state web site. The SHIP's goals: to improve our state population's health and the quality of of the care we receive and to lower the cost of all that care.
Rhode Island is home to some amazing health care providers and institutions - no doubt about it. But just because we've got some great doctors and hospitals doesn't mean we're all set. What's wrong, according to the plan's authors, is that our system is fragmented. Coordinating would make us healthier and cost less.
Here's an example: you get taken to the hospital for a heart attack, where you might get great emergency care. But then you're sent home without anyone following up to help you change the lifestyle habits (diet, exercise) that likely led to that heart attack, likely leading to more health problems down the road. Your regular doctor, if you have one, never knows about your hospitalization, because he won't get paid for coordinating your care or following up with a phone call. You get a bill from the ER doctor, from the hospital, from the pharmacy, from various labs and providers. And if you don't make some major changes in your lifestyle, you could very well end up going through the same thing again in the near future.
Regular primary care, with a team of providers like nutritionists, nurse case managers, and, of course, a regular physician, could have spotted your risk for a heart attack earlier and helped you manage it. But we don't have many health care teams that coordinate patient care (although that's changing). You're on your own, for the most part. The impact? You're not healthier, and you're certainly not wealthier. Hospitalizations are expensive; lifestyle changes are relatively cheap.
Wouldn't it better to pay health care providers to keep you healthy, rather than pay them for each service, each 15 minute visit, each procedure they do? Lieutenant Governor Elizabeth Roberts and the team that put together this plan think so. Just some of their ambitious goals:
- move 80% of Rhode Islanders into value-based health care arrangements (as opposed to fee-for-service arrangements) in five years
- slow the rate of growth of health care spending
- reduce hospital re-admissions
- reduce unnecessary ER visits
- increase access to primary care
- decrease deaths from painkiller overdose
How do you do this? Around page 38, the SHIP breaks down some of the actions we can take to achieve these goals. There aren't a ton of specifics, but the plan lists some regulatory measures, some public-private cooperation, and the development of some new public and private programs. It looks like insurers, health care providers, and state policymakers will have to hold lots of meetings and draft lots of agreements to make some of this happen. We're talking about a seismic shift, after all, in the way we pay for health care and deliver it. And that won't happen overnight.
Lt. Gov. Roberts told me in a phone conversation last week that the plan will be up for public comment for a few weeks. Then it goes to the feds for review. And if they accept it, Roberts says Rhode Island will apply in the spring for a big grant - up to $50 million dollars - to begin implementing parts of the plan.
You might think that only health policy wonks will want to read the plan and comment on it. But I'd recommend reading at least the first parts. It's a great overview of the state's health care system - what we've got, what's working, what's not. It details the major health care initiatives underway in the state, outlines our major health problems, and would have been a very helpful document for me when I first started covering health care in this state!