The Pulse: To Curb Health Care Costs, Patience And Perseverance

Dec 3, 2015

If your health insurance deductibles and co-pays have been rising, you’re not alone. A recent report about the cost of health care in the Ocean State found that consumers’ out-of-pocket costs for care have been rising faster than the actual price of health care services. 

On this week’s The Pulse, Rhode Island Public Radio’s Kristin Gourlay joins news director Elisabeth Harrison to talk about the latest efforts to curb those costs – and keep us healthy.

Here's a transcript of their conversation. Or you can listen to it here.

ELISABETH: Hi Kristin. So, this week, you reported that a working group appointed by the governor will make four recommendations to curb costs. One of them is to establish a spending target for health care providers and insurers, kind of like a limit on how much they can raise prices.

KRISTIN: That’s right. Another recommendation: to create an office of health care policy to coordinate all of these health care reform efforts. But Elisabeth – before you roll your eyes at the phrase “health care reform,” let me reassure you. I’m not going to run through a boring list of recommendations. You won’t need your English-to-health policy wonk dictionary. Instead, let’s talk about some of the actual problems Rhode Islanders are facing when it comes to health care. Then we can talk about what’s been proposed to solve those problems.

ELISABETH: Sounds good. So, what’s one of the biggest problems?

KRISTIN: Health care is expensive. And it keeps getting more expensive every year. I’m talking about what you pay out of pocket for visiting the doctor, going to the emergency room, the deductible you have to meet before your insurance kicks in. What comes out of your paycheck every month to pay health insurance premiums. Everyone agrees…. these rising costs…. they’re not sustainable. 

ELISABETH: OK, Kristin Gourlay, that’s not a new problem. But are there new solutions? Apart from just telling health insurance companies to knock it off.

KRISTIN: Well, it’s not that simple unfortunately. But this latest working group is proposing solutions in a couple of flavors – not new ideas, but I’m hearing they might have a better chance at succeeding than some previous efforts.

ELISABETH: Because the governor is on board?

KRISTIN: Not only that, but I think health insurance companies and hospitals and doctors and Medicaid – they can all see that this problem is reaching a crisis point. People are putting off health care because it costs too much. Health insurers like Medicaid are restricting access to certain drugs because they cost so much.

So I mentioned the solutions come in a couple of flavors. One flavor is: “let’s bring all these prices out in the open.” If health care providers have to be up front about what their services cost, that will be a good incentive to keep those costs reasonable. The working group proposes an annual hearing about the trend in costs. And they’d require any hospital or insurer reporting a big price increase to explain themselves and come up with a plan to fix it.

The other flavor is: “let’s get more bang for our buck.” So, let’s stop paying for every stitch, every aspirin, every dose of anesthesia, every follow up visit after a surgery. Instead, let’s pay hospitals and doctors to keep a group of people healthy and out of the hospital. Let’s pay for a total package of services, and let doctors decide how to deliver them. That would make costs more predictable – and, hopefully, keep them from going up too much, too fast.

ELISABETH: Kristin you mentioned these aren’t new ideas. We’ve been sampling these “flavors” for years now. What is taking so long? I mean, you and I can both remember the itemized bills we got for giving birth. You pay this doctor for this service, that doctor for that service. What about one price that includes everything?

KRISTIN: Great example. That’s what a lot of people who pay for health care would like to see. But it’s like turning around a battleship…on a dime. Not feasible….in the short term. I called up Cranston Senator Josh Miller, who has introduced lots of health care legislation over the years, to try to get a sense of how all these attempts to turn this battleship around have fared. He said first of all, some progress has been made. The state has a federal grant to help try out some of these new payment models. They include things like paying a set monthly fee per patient, or letting health care providers share in some of the savings if they keep costs down. And the Office of the Health Commissioner has some power to monitor and enforce the progress this ship is making as it slowly turns around.

ELISABETH: But we haven’t really seen any serious drops in health care costs. It still seems these efforts are slow to show any noticeable impact on what the average Rhode Islander pays for health care.

KRISTIN: You’re right. Senator Miller told me that every year since he’s been in office, since about 2007, one piece of legislation or another has been proposed to make health care more affordable, or to improve quality. There have been so many task forces, working groups, commissions, reports, bills, committees…I asked Miller how many fingers it would take to count the number he’s been a part of and he laughed. But he said in the end, some of the efforts unravel because there’s opposition from health care providers, like hospitals. Or the legislation or committee or whoever is in charge just doesn’t have enough force to compel change. Or people disagree on how to implement a plan. But he seems optimistic about recent efforts. For one, he says the problems are more urgent than ever. And the conversation about what has to change is no longer confined to a small room with a few committee members – it’s broader. There are lots of stakeholders. And it’s not just our individual pocket books but our health that’s on the line.